Diagnosis and Management of Nonislet Cell Tumor Hypoglycemia: Case Series and Review of the LiteratureNayar, Manu K. MRCP*; Lombard, Martin G. MD, FRCP†; Furlong, Niall J. MD, MRCP‡; McNulty, Sid J. FRCP‡; Hardy, Kevin J. MD, FRCP‡; Vora, Jiten MD, FRCP§Author Information *Specialist Registrar in Gastroenterology, and †Consultant Gastroenterologist, Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, U.K.; ‡Consultant Physician and Endocrinologist, Department of Medicine, St. Helens and Knowsley Hospital, Merseyside, U.K.; and §Consultant Physician and Endocrinologist, Department of Endocrinology, Royal Liverpool University Hospital, Liverpool, U.K. The authors have disclosed that they have no significant relationships with or financial interests in any commercial company that pertains to this educational activity. Lippincott Continuing Medical Education Institute, Inc. has identified and resolved all faculty conflicts of interest regarding this educational activity. Reprints: M. K. Nayar, MRCP, 17 Druids Cross Road, Calderstones, Merseyside, L18 3EA, U.K. E-mail: [email protected] Chief Editor's Note: This article is the 24th of 36 that will be published in 2006 for which a total of up to 36 AMA PRA Category 1 Credits™ can be earned. Instructions for how credits can be earned precede the CME Examination at the back of this issue. The Endocrinologist: July/August 2006 - Volume 16 - Issue 4 - pp 227-230 doi: 10.1097/01.ten.0000226008.02412.0b Buy Take the CME Test Metrics Abstract Tumor-associated hypoglycemia is a well-documented but rare cause of hypoglycemia. There are 2 major causes: fasting hypoglycemia associated with unregulated insulin production by islet-cell tumors (“insulinomas”) and, more commonly, noninsulin-mediated fasting hypoglycemia induced by extrapancreatic tumors, so-called nonislet cell tumor hypoglycemia (NICTH). Although surgical debulking is the treatment of choice, many cases involve elderly patients with incurable tumors, in which freedom from tumor-related hypoglycemia is a key factor determining quality of life (and short-term survival). Therefore, a combination of dietetic and specific medical treatments, including glucocorticoids, human recombinant growth hormone, glucagon, and somatostatin analogs, alone or in combination, remains the mainstay of treatment of majority of the patients. We present our experience in the management of NICTH in 6 patients with the various modalities of medical treatment. © 2006 Lippincott Williams & Wilkins, Inc.