The riddle of tumour hypoglycaemia revisited.

In summary, hypoglycaemia due to non-pancreatic tumour is relatively common among the causes of fasting hypoglycaemia in the adult. Most of the neoplasms are large, and present as masses in the mediastinum or retroperitoneal space. Although therapy is difficult, successful palliation by surgery or radiotherapy has been achieved in a number of cases. Although many theories have been advanced to explain the hypoglycaemia, the best documented mechanism is production of an insulin-like substance by the tumour. Both low molecular weight (NSILA-s) and high molecular weight (SNILP) peptides have been reported to be elevated in some cases of tumour hypoglycaemia. Further study of this class of peptides will no doubt lead to assays that may facilitate diagnosis of tumour hypoglycaemia, as well as offer new approaches to the therapy of this disease.