Hypoglycemia Due to an Insulin-Secreting Small-Cell Carcinoma of the Cervix

Abstract

Hypoglycemia is a condition commonly seen in the emergency department and is usually caused by insulin or sulfonylurea therapy for diabetes mellitus. Tumor-induced hypoglycemia occurs more rarely and can involve several mechanisms, according to whether the tumor is of pancreatic islet-cell origin or of extrapancreatic, non–islet-cell origin.¹ The pancreatic islet beta-cell tumors (insulinomas) cause hypoglycemia by producing excessive insulin. In contrast, non–islet-cell tumors can cause hypoglycemia in any of several ways. They include release by the tumor of insulin-like growth factor II or its high-molecular-weight precursor,^2-4 multiple metastases to the liver, massive tumor burden, or rarely, the production of autoantibodies to insulin or its receptor.^5-7 However, there is considerable debate over whether non–islet-cell tumors can secrete insulin.¹