Insulin-like growth factor II-producing metastatic colon cancer with recurrent hypoglycemia

Clin J Gastroenterol. 2015 Feb;8(1):35-40. doi: 10.1007/s12328-015-0552-4. Epub 2015 Jan 21.


A 45-year-old man was referred to our hospital and found to have a tubular adenocarcinoma of the descending colon with multiple liver metastases. During hospitalization, the patient suffered recurrent hypoglycemic attacks that required intravenous 50% glucose infusion. He was diagnosed with non-islet cell tumor hypoglycemia (NICTH) because the colon cancer tissue obtained by biopsy was strongly stained for insulin-like growth factor-II (IGF-II) by immunohistochemistry. He received chemotherapy with oxaliplatin, 5-FU and leucovorin (FOLFOX) plus bevacizumab (Bmab), and showed a partial response. As the metastatic lesions decreased in size, the hypoglycemic attacks gradually disappeared. Subsequently, he received outpatient chemotherapy and maintained a high quality of life for about 10 months. Western blot analysis of IGF-II in serum at the time of admission showed a high-molecular-weight form of IGF-II, which was considered to have caused hypoglycemia. This patient presents a very rare case of colorectal cancer associated with NICTH syndrome due to production of high-molecular-weight IGF-II by cancer cells. It is important to investigate IGF-II expression in cancer tissues for establishing the diagnosis of NICTH in cases with intractable hypoglycemia complicated by advanced cancer.

Publication types

  • Case Reports

MeSH terms

  • Adenocarcinoma / chemistry
  • Adenocarcinoma / complications*
  • Adenocarcinoma / pathology*
  • Blotting, Western
  • Colonic Neoplasms / chemistry
  • Colonic Neoplasms / complications*
  • Colonic Neoplasms / pathology*
  • Humans
  • Hypoglycemia / etiology*
  • Immunohistochemistry
  • Insulin-Like Growth Factor II / analysis*
  • Liver Neoplasms / secondary
  • Male
  • Middle Aged
  • Recurrence


  • Insulin-Like Growth Factor II