{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T17:48:28Z","timestamp":1766512108213,"version":"3.48.0"},"reference-count":20,"publisher":"Bioscientifica","issue":"4","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"\n Summary<\/jats:title>\n Insulin-like growth factor II (IGF-II)-secreting tumours represent a subset of non-islet cell tumours and are a rare but potentially life-threatening cause of paraneoplastic hypoglycaemia. They are predominantly associated with epithelial or mesenchymal tumours but have also been reported in some hepatocellular carcinomas or retroperitoneal sarcomas. Definitive treatment involves surgical resection of the mass; however, if that is not possible, then various forms of medical management can be trialled. This paper presents the case of a 91-year-old woman admitted to hospital with worsening pelvic pain. Throughout the admission, she was found to have recurrent episodes of hypoglycaemia that, when investigated, were attributed to a bladder tumour. She was diagnosed with an IGF-II-secreting non-islet cell tumour based on imaging, biochemistry, and clinical judgement. Due to her age and limited physical reserve, she declined further investigation or surgical management, leading to trial and successful medical management of her condition. This case highlights a rare presentation of IGF-II-mediated non-islet cell tumour hypoglycaemia arising from the bladder in an elderly patient, which has minimal representation in the literature.<\/jats:p>\n <\/jats:sec>\n \n Learning points<\/jats:title>\n \n \n Unexplained and recurrent episodes of hypoglycaemia should raise clinical suspicion of a paraneoplastic process that requires further investigation.<\/jats:p>\n <\/jats:list-item>\n \n It is important to maintain a broad range of differentials when approaching a frail patient with recurrent hypoglycaemia. Management should be guided by discussion with a multidisciplinary team and patient preference.<\/jats:p>\n <\/jats:list-item>\n \n IGF-II-secreting tumours are widely associated with mesenchymal tumours; however, this case presents a rare possible association with bladder tumours.<\/jats:p>\n <\/jats:list-item>\n \n Surgical resection of NICTH tumours is the mainstay of treatment, but when it is not feasible, other medical management should be explored.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>","DOI":"10.1530\/edm-25-0090","type":"journal-article","created":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T17:25:18Z","timestamp":1764696318000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":0,"title":["IGF-II-secreting bladder tumour presenting as a fall in a 91-year-old"],"prefix":"10.1530","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-5965-8808","authenticated-orcid":true,"given":"Imaan","family":"Hirji","sequence":"first","affiliation":[{"name":"Royal Surrey NHS Foundation Trust, Guildford, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shwetha","family":"Sairam","sequence":"additional","affiliation":[{"name":"Royal Surrey NHS Foundation Trust, Guildford, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiro","family":"Khoshnaw","sequence":"additional","affiliation":[{"name":"Royal Surrey NHS Foundation Trust, Guildford, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Endocrinol Diabetes Metab Case Rep","first-page":"23","article-title":"IGF-2-mediated hypoglycemia: a case series and review of the medical therapies for refractory hypoglycemia","volume":"2024","author":"Vu A","year":"2024","unstructured":"Vu A\n, \nChik C\n & \nKwong S\n\n. IGF-2-mediated hypoglycemia: a case series and review of the medical therapies for refractory hypoglycemia. Endocrinol Diabetes Metab Case Rep 2024 2024 23\u201389. (https:\/\/doi.org\/10.1530\/EDM-23-0089)"},{"key":"bib2","series-title":"Arab J Urol","first-page":"54","article-title":"Bladder leiomyoma: presentation, evaluation and treatment","volume":"11","author":"Khater N","year":"2013","unstructured":"Khater N\n & \nSakr G\n\n. Bladder leiomyoma: presentation, evaluation and treatment. Arab J Urol 2013 11 54\u201361. (https:\/\/doi.org\/10.1016\/j.aju.2012.11.007)"},{"key":"bib3","series-title":"BMC Urol","first-page":"252","article-title":"Characteristics and outcomes in bladder leiomyoma management: a systematic review of case reports and case series from the past 20 years","volume":"24","author":"Prihadi JC","year":"2024","unstructured":"Prihadi JC\n, \nHengky A\n, \nLionardi SK\n, et al.\n Characteristics and outcomes in bladder leiomyoma management: a systematic review of case reports and case series from the past 20 years. BMC Urol 2024 24 252. (https:\/\/doi.org\/10.1186\/s12894-024-01624-3)"},{"key":"bib4","series-title":"Endocrinol Diabetes Metab","article-title":"A systematic review of literature on insulin-like growth factor-2-mediated hypoglycaemia in non-islet cell tumours","volume":"7","author":"Ata F","year":"2024","unstructured":"Ata F\n, \nChoudry HA\n, \nKhan AA\n, et al.\n A systematic review of literature on insulin-like growth factor-2-mediated hypoglycaemia in non-islet cell tumours. Endocrinol Diabetes Metab 2024 7 e00471. (https:\/\/doi.org\/10.1002\/edm2.471)"},{"key":"bib5","series-title":"Int J Urol Case Rep","first-page":"9","article-title":"Bladder urothelial carcinoma producing insulin-like growth factor II: a case report","volume":"1","author":"Funada S","year":"2018","unstructured":"Funada S\n, \nKita Y\n, \nOkada Y\n, et al.\n Bladder urothelial carcinoma producing insulin-like growth factor II: a case report. Int J Urol Case Rep 2018 1 9\u201312. (https:\/\/doi.org\/10.1002\/iju5.12018)"},{"key":"bib6","series-title":"Eur Urol","first-page":"484","article-title":"Solitary fibrous tumour of the urinary bladder with expression of bcl-2, CD34, and insulin-like growth factor type II","volume":"39","author":"Corti B","year":"2001","unstructured":"Corti B\n, \nCarella R\n, \nGabusi E\n, et al.\n Solitary fibrous tumour of the urinary bladder with expression of bcl-2, CD34, and insulin-like growth factor type II. Eur Urol 2001 39 484\u2013488. (https:\/\/doi.org\/10.1159\/000052490)"},{"key":"bib7","series-title":"BMC Endocr Disord","first-page":"59","article-title":"Non-islet cell tumor hypoglycemia (NICTH) associated with sarcoma: a case report","volume":"25","author":"Jannatalipour A","year":"2025","unstructured":"Jannatalipour A\n, \nPanahi N\n, \nPejman Sani M\n, et al.\n Non-islet cell tumor hypoglycemia (NICTH) associated with sarcoma: a case report. BMC Endocr Disord 2025 25 59. (https:\/\/doi.org\/10.1186\/s12902-025-01885-5)"},{"key":"bib8","series-title":"Int J Gynecol Pathol","first-page":"79","article-title":"Solitary fibrous tumor of the uterus producing high-molecular-weight insulin-like growth factor II and associated with hypoglycemia","volume":"24","author":"Wakami K","year":"2005","unstructured":"Wakami K\n, \nTateyama H\n, \nKawashima H\n, et al.\n Solitary fibrous tumor of the uterus producing high-molecular-weight insulin-like growth factor II and associated with hypoglycemia. Int J Gynecol Pathol 2005 24 79\u201384. (https:\/\/doi.org\/10.1097\/01.pgp.0000148342.07759.a8)"},{"key":"bib9","series-title":"N Engl J Med","first-page":"1434","article-title":"Synthesis and secretion of insulin-like growth factor II by a leiomyosarcoma with associated hypoglycemia","volume":"319","author":"Daughaday WH","year":"1988","unstructured":"Daughaday WH\n, \nEmanuele MA\n, \nBrooks MH\n, et al.\n Synthesis and secretion of insulin-like growth factor II by a leiomyosarcoma with associated hypoglycemia. N Engl J Med 1988 319 1434\u20131440. (https:\/\/doi.org\/10.1056\/NEJM198812013192202)"},{"key":"bib10","series-title":"J Clin Endocrinol Metab","first-page":"713","article-title":"Management of non-islet-cell tumor hypoglycemia: a clinical review","volume":"99","author":"Bodnar TW","year":"2013","unstructured":"Bodnar TW\n, \nAcevedo MJ\n & \nPietropaolo M\n\n. Management of non-islet-cell tumor hypoglycemia: a clinical review. J Clin Endocrinol Metab 2013 99 713\u2013722. (https:\/\/doi.org\/10.1210\/jc.2013-3382)"},{"key":"bib1","series-title":"Endocrinol Diabetes Metab Case Rep","first-page":"23","article-title":"IGF-2-mediated hypoglycemia: a case series and review of the medical therapies for refractory hypoglycemia","volume":"2024","author":"Vu A","year":"2024","unstructured":"Vu A\n, \nChik C\n & \nKwong S\n\n. IGF-2-mediated hypoglycemia: a case series and review of the medical therapies for refractory hypoglycemia. Endocrinol Diabetes Metab Case Rep 2024 2024 23\u201389. (https:\/\/doi.org\/10.1530\/EDM-23-0089)"},{"key":"bib2","series-title":"Arab J Urol","first-page":"54","article-title":"Bladder leiomyoma: presentation, evaluation and treatment","volume":"11","author":"Khater N","year":"2013","unstructured":"Khater N\n & \nSakr G\n\n. Bladder leiomyoma: presentation, evaluation and treatment. Arab J Urol 2013 11 54\u201361. (https:\/\/doi.org\/10.1016\/j.aju.2012.11.007)"},{"key":"bib3","series-title":"BMC Urol","first-page":"252","article-title":"Characteristics and outcomes in bladder leiomyoma management: a systematic review of case reports and case series from the past 20 years","volume":"24","author":"Prihadi JC","year":"2024","unstructured":"Prihadi JC\n, \nHengky A\n, \nLionardi SK\n, et al.\n Characteristics and outcomes in bladder leiomyoma management: a systematic review of case reports and case series from the past 20 years. BMC Urol 2024 24 252. (https:\/\/doi.org\/10.1186\/s12894-024-01624-3)"},{"key":"bib4","series-title":"Endocrinol Diabetes Metab","article-title":"A systematic review of literature on insulin-like growth factor-2-mediated hypoglycaemia in non-islet cell tumours","volume":"7","author":"Ata F","year":"2024","unstructured":"Ata F\n, \nChoudry HA\n, \nKhan AA\n, et al.\n A systematic review of literature on insulin-like growth factor-2-mediated hypoglycaemia in non-islet cell tumours. Endocrinol Diabetes Metab 2024 7 e00471. (https:\/\/doi.org\/10.1002\/edm2.471)"},{"key":"bib5","series-title":"Int J Urol Case Rep","first-page":"9","article-title":"Bladder urothelial carcinoma producing insulin-like growth factor II: a case report","volume":"1","author":"Funada S","year":"2018","unstructured":"Funada S\n, \nKita Y\n, \nOkada Y\n, et al.\n Bladder urothelial carcinoma producing insulin-like growth factor II: a case report. Int J Urol Case Rep 2018 1 9\u201312. (https:\/\/doi.org\/10.1002\/iju5.12018)"},{"key":"bib6","series-title":"Eur Urol","first-page":"484","article-title":"Solitary fibrous tumour of the urinary bladder with expression of bcl-2, CD34, and insulin-like growth factor type II","volume":"39","author":"Corti B","year":"2001","unstructured":"Corti B\n, \nCarella R\n, \nGabusi E\n, et al.\n Solitary fibrous tumour of the urinary bladder with expression of bcl-2, CD34, and insulin-like growth factor type II. Eur Urol 2001 39 484\u2013488. (https:\/\/doi.org\/10.1159\/000052490)"},{"key":"bib7","series-title":"BMC Endocr Disord","first-page":"59","article-title":"Non-islet cell tumor hypoglycemia (NICTH) associated with sarcoma: a case report","volume":"25","author":"Jannatalipour A","year":"2025","unstructured":"Jannatalipour A\n, \nPanahi N\n, \nPejman Sani M\n, et al.\n Non-islet cell tumor hypoglycemia (NICTH) associated with sarcoma: a case report. BMC Endocr Disord 2025 25 59. (https:\/\/doi.org\/10.1186\/s12902-025-01885-5)"},{"key":"bib8","series-title":"Int J Gynecol Pathol","first-page":"79","article-title":"Solitary fibrous tumor of the uterus producing high-molecular-weight insulin-like growth factor II and associated with hypoglycemia","volume":"24","author":"Wakami K","year":"2005","unstructured":"Wakami K\n, \nTateyama H\n, \nKawashima H\n, et al.\n Solitary fibrous tumor of the uterus producing high-molecular-weight insulin-like growth factor II and associated with hypoglycemia. Int J Gynecol Pathol 2005 24 79\u201384. (https:\/\/doi.org\/10.1097\/01.pgp.0000148342.07759.a8)"},{"key":"bib9","series-title":"N Engl J Med","first-page":"1434","article-title":"Synthesis and secretion of insulin-like growth factor II by a leiomyosarcoma with associated hypoglycemia","volume":"319","author":"Daughaday WH","year":"1988","unstructured":"Daughaday WH\n, \nEmanuele MA\n, \nBrooks MH\n, et al.\n Synthesis and secretion of insulin-like growth factor II by a leiomyosarcoma with associated hypoglycemia. N Engl J Med 1988 319 1434\u20131440. (https:\/\/doi.org\/10.1056\/NEJM198812013192202)"},{"key":"bib10","series-title":"J Clin Endocrinol Metab","first-page":"713","article-title":"Management of non-islet-cell tumor hypoglycemia: a clinical review","volume":"99","author":"Bodnar TW","year":"2013","unstructured":"Bodnar TW\n, \nAcevedo MJ\n & \nPietropaolo M\n\n. Management of non-islet-cell tumor hypoglycemia: a clinical review. J Clin Endocrinol Metab 2013 99 713\u2013722. (https:\/\/doi.org\/10.1210\/jc.2013-3382)"}],"container-title":["Endocrinology, Diabetes & Metabolism Case Reports"],"original-title":[],"link":[{"URL":"https:\/\/edm.bioscientifica.com\/view\/journals\/edm\/2025\/4\/EDM-25-0090.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2025\/4\/EDM-25-0090.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2025\/4\/EDM-25-0090.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T17:43:55Z","timestamp":1766511835000},"score":1,"resource":{"primary":{"URL":"https:\/\/edm.bioscientifica.com\/view\/journals\/edm\/2025\/4\/EDM-25-0090.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,1]]},"references-count":20,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.1530\/edm-25-0090","relation":{},"ISSN":["2052-0573"],"issn-type":[{"type":"electronic","value":"2052-0573"}],"subject":[],"published":{"date-parts":[[2025,10,1]]}}}