SHM Converge Scientific Abstract ePoster Gallery-Hidden but Treatable: Igf-2-Mediated Hypoglycemia in a Patient With Cervical Squamous Cell Carcinoma

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This document is a case report describing <strong>IGF-2–mediated non-islet cell tumor hypoglycemia</strong> in a 60-year-old woman with <strong>stage IVB cervical squamous cell carcinoma</strong>. She had recurrent severe hypoglycemia, with finger-stick glucose as low as <strong>33 mg/dL</strong>, despite stopping diabetes medications months earlier. Other possible causes were considered, including poor oral intake, cachexia, acute kidney injury, hypothyroidism, adrenal insufficiency, and liver involvement, but several were ruled out.

The report explains the biology of <strong>normal vs. tumor-related IGF-2</strong>. Normally, IGF-2 is expressed only from the paternal allele and is mostly carried in larger binding complexes, limiting free circulating IGF-2. In tumors, loss of imprinting can increase IGF-2 production and dissociation into a free, bioactive form. This can bind insulin-like receptors and drive glucose uptake, suppress gluconeogenesis, and cause hypoglycemia.

Diagnostic labs during hypoglycemia showed <strong>low insulin, low C-peptide, low beta-hydroxybutyrate, low IGF-1, normal IGF-2, and an elevated IGF-2/IGF-1 ratio of 19.7</strong> (normal about 3:1), supporting IGF-2-mediated hypoglycemia. AM cortisol was normal, but thyroid studies showed uncontrolled hypothyroidism.

Treatment options noted include surgical resection when feasible, and medical therapy such as <strong>corticosteroids, octreotide, and diazoxide</strong>. In this case, the patient was started empirically on <strong>prednisone 10 mg daily</strong>, which improved her hypoglycemia.

The key takeaway is that <strong>IGF-2-mediated hypoglycemia should be considered in patients with advanced malignancy and refractory hypoglycemia</strong>, because it may represent a treatable contributor, even in cancers not previously known to cause it, such as cervical carcinoma.

Asset Subtitle

Shengming Li

Meta Tag

Author List Donna Lee, Franklin Liu, Maurizio Camere Pastor, Reyna Aguilar, Shengming Li

Category Clinical Vignettes

Concept IGF-2Mediated Non-Islet Cell Tumor Hypoglycemia

Concept Hypoglycemia

Concept Insulin-like Growth Factor 2

Concept IGF-2/IGF-1 Ratio

Concept Advanced Solid Tumor

Distinguished Finalist

Presenter Organization Department of Medicine, NYC Health + Hospitals/Elmhurst, Icahn School of Medicine at Mount Sinai

Presenting Author Shengming Li

Track Adult

Keywords

IGF-2-mediated hypoglycemia

non-islet cell tumor hypoglycemia

cervical squamous cell carcinoma

stage IVB malignancy

severe recurrent hypoglycemia

elevated IGF-2/IGF-1 ratio

low insulin and C-peptide

prednisone treatment

tumor-related IGF-2

advanced cancer hypoglycemia

IGF-2Mediated Non-Islet Cell Tumor Hypoglycemia

Hypoglycemia

Insulin-like Growth Factor 2

IGF-2/IGF-1 Ratio

Advanced Solid Tumor