{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:16:48Z","timestamp":1784557008318,"version":"3.55.0"},"reference-count":9,"publisher":"Bioscientifica","content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2016,11,4]]},"abstract":"Summary<\/jats:title>\n Adrenacarcinomas are rare, and hypoglycemic syndrome resulting from the secretion of insulin-like growth factor II (IGF-II) by these tumors have been described infrequently. This study describes the case of a young woman with severe persistent hypoglycemia and a large adrenal tumor and discusses the physiopathological mechanisms involved in hypoglycemia. The case is described as a 21-year-old woman who presented with 8 months of general symptoms and, in the preceding 3 months, with episodes of mental confusion and visual blurring secondary to hypoglycemia. A functional assessment of the adrenal cortex revealed ACTH-independent hypercortisolism and hyperandrogenism. Hypoglycemia, hypoinsulinemia, low C-peptide and no ketones were also detected. An evaluation of the GH\u2013IGF axis revealed GH blockade (0.03; reference: up to 4.4\u2009ng\/mL), greatly reduced IGF-I levels (9.0\u2009ng\/mL; reference: 180\u2013780\u2009ng\/mL), slightly reduced IGF-II levels (197\u2009ng\/mL; reference: 267\u2013616\u2009ng\/mL) and an elevated IGF-II\/IGF-I ratio (21.9; reference: ~3). CT scan revealed a large expansive mass in the right adrenal gland and pulmonary and liver metastases. During hospitalization, the patient experienced frequent difficult-to-control hypoglycemia and hypokalemia episodes. Octreotide was ineffective in controlling hypoglycemia. Due to unresectability, chemotherapy was tried, but after 3 months, the patient\u2019s condition worsened and progressed to death. In conclusion, our patient presented with a functional adrenal cortical carcinoma, with hyperandrogenism associated with hypoinsulinemic hypoglycemia and blockage of the GH\u2013IGF-I axis. Patient\u2019s data suggested a diagnosis of hypoglycemia induced by an IGF-II or a large IGF-II-producing tumor (low levels of GH, greatly decreased IGF-I, slightly decreased IGF-II and an elevated IGF-II\/IGF-I ratio).<\/jats:p>\n \n Learning points:<\/jats:title>\n \n \n Hypoglycemyndrome resulting from the secretion of insulin-like growth factor II (IGF-II) by adrenal tumors is a rare condition.<\/jats:p>\n <\/jats:list-item>\n \n Hypoinsulinemic hypoglycemia associated with hyperandrogenism and blockage of the GH\u2013IGF-I axis suggests hypoglycemia induced by an IGF-II or a large IGF-II-producing tumor.<\/jats:p>\n <\/jats:list-item>\n \n Hypoglycemia in cases of NICTH should be treated with glucocorticoids, glucagon, somatostatin analogs and hGH.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n 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