Hypoglycemia associated with the production of insulin-like growth factor II in adrenocortical carcinoma

A 78-year-old woman was hospitalized for congestive heart failure and repea ted hypoglycemic attacks. The laboratory data showed a serum insulin level within the normal range and an increased level of serum insulin-like growth factor (IGF) Il. Abdominal ultrasonogram and computed tomography scan reve aeled a huge mass lying above the left kidney. She was diagnosed as having an adrenocortical carcinoma. After the removal of the tumor, the plasma glu cose level and the serum level of IGF-II were normalized. The tumor cells s tained positively for IGF-II immunohistochemically. These findings suggeste d that the hypoglycemia was due to IGF-II produced by the adrenocortical ca rcinoma.