Non-islet cell tumor hypoglycemia (NICTH)
IGF-2-mediated hypoglycemia1,2
Non-islet cell tumor hypoglycemia (NICTH) is a rare, paraneoplastic hypoglycemia associated with extra-pancreatic tumors, typically of epithelial or mesenchymal origin.
Malignant (or less often, benign) tumors secrete an intermediate molecule of insulin-like growth factor 2 (IGF-2) referred to as “big” IGF-2, which activates insulin receptors. Increased bioavailability of IGF-2 variants suppresses glucose production and increases peripheral glucose uptake, leading to recurrent hypoglycemia.
Management is currently limited for NICTH1,2:
- Resection is the first-line standard for treatment, but is often unfeasible in cases of advanced disease and recurrence is possible
- Tumor-directed therapies are often ineffective at controlling severe hypoglycemia
- Conventional hypoglycemia management is not sustainable for recurrent episodes associated with non-islet cell tumor hypoglycemia—marking a significant unmet need for targeted, hypoglycemia-directed therapies
Know the signs
The signs and symptoms of hypoglycemia associated with non-islet cell tumors may go undetected until a potentially life-threatening emergency. Evaluate your patients early.1,3
See the unmet need
Without adequate hypoglycemia-directed therapies, evidence-based management protocol for NICTH is limited. Understand the current treatment options.1,2
Consult early
Early collaboration between endocrinologists and oncologists is key to the diagnosis and management of NICTH. Consider early consultation.1
Stay up to date on the latest developments in NICTH
Sign UpReferences: 1. Karamanolis N, et al. Paraneoplastic hypoglycemia: an overview for optimal clinical guidance. Metab Open. 2024;23(100305):1-9. doi.org/10.1016/j.metop.2024.100305 2. Bodnar T, et al. Management of non-islet cell tumor hypoglycemia: a clinical review. J Clin Endocrinol Metab. 2013;99(3):713-722. doi:10.1210/jc.2013-3382 3. Voon K, et al. Three cases of non-islet cell tumor hypoglycemia highlighting efficacy of glucocorticoid treatment. JCEM Case Rep. 2023;1(4):1-4. doi.org/10.1210/jcemcr/luad045
