Hypoglycemia as a paraneoplastic syndrome -current state of knowledge
Abstract
Objective
To provide a comprehensive overview of current knowledge on paraneoplastic hypoglycemia, with particular focus on non-islet cell tumor hypoglycemia, including its epidemiology, pathophysiology, tumor associations, clinical presentation, diagnostic approach and management.
Methods
A narrative literature review based on a structured literature search was conducted using literature retrieved from PubMed, Google Scholar and SpringerLink. Publications from 2020-2026 were screened using keywords related to non-islet cell tumor hypoglycemia and paraneoplastic hypoglycemia.
Results
Non-islet cell tumor hypoglycemia most commonly arises from mesenchymal tumors, particularly solitary fibrous tumors, but has also been reported in a broad spectrum of other tumor types. Hypoglycemia results from tumor overproduction of insulin-like growth factor two, especially its high-molecular-weight form, which mimics insulin activity. Patients typically present with fasting hypoglycemia, adrenergic and neuroglycopenic symptoms. Diagnosis is supported by a markedly elevated insulin-like growth factor two to insulin-like growth factor one ratio. Surgical tumor resection is the primary treatment; in unresectable cases, glucocorticoids, recombinant growth hormone, radio-therapy, or other emerging therapies may be used.
Conclusions
Early recognition and understanding of the diverse tumors causing non-islet cell tumor hypoglycemia are crucial to prevent hypoglycemia-related complications and support effective management.
© 2026 Katarzyna Szeliga, Wiktoria Kolasa, Magdalena Kolanko, Anna Korzeniowska, Patrycja Kosidło, Greta Stołecka, Julia Grabowska, Joanna Jędrysiak, Karolina Mikółka, Martyna Lelonkiewicz, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution 4.0 License.