65 A recent systematic review has revealed that a majority of rare hypoglycaemia cases in patients with non-islet cell tumours are linked to fibrous tumours. The study, published in Endocrinology, Diabetes & Metabolism, explores the relationship between Insulin-like Growth Factor-2 (IGF-2) and hypoglycaemia, particularly in patients with non-diabetic conditions. This type of hypoglycaemia is known to have a serious impact on patient outcomes. The findings were published in the journal Endocrinology, Diabetes & Metabolism. The research focuses on IGF-2-mediated hypoglycaemia, a rare but dangerous condition where elevated levels of the hormone mimic the effects of insulin, resulting in severely low blood sugar. Non-islet cell tumour hypoglycaemia (NICTH) is typically observed in patients with tumours outside of the pancreas, with fibrous tumours being the most common culprit. The review analysed data from 172 studies, which included a total of 233 patients. These cases comprised 150 individual case reports, highlighting how little large-scale research exists on this condition. The average age of patients was around 60 years, with an almost equal distribution of male and female cases. The study found that fibrous tumours accounted for over half of all cases (53.2%). These are tumours that arise from fibrous tissue, such as fibromas and fibrosarcomas, which have the highest likelihood of producing elevated IGF-2 levels. Other tumours linked to hypoglycaemia included those originating from the liver, hemangiopericytomas, and mesotheliomas. IGF-2 is typically involved in tissue growth and repair, particularly during embryonic development, but when produced in excessive quantities by certain tumours, it leads to low blood sugar. The review noted that while hypoglycaemia was the initial presenting symptom in about 42% of cases, other common symptoms included confusion and loss of consciousness. In the most severe cases, this condition can lead to death if not properly managed. Given the severity of the condition, surgical removal of the tumour was identified as the most common and effective treatment. Nearly half of the patients (47.2%) underwent surgery, with most seeing significant improvement in their condition. Other treatment options, such as medications like corticosteroids, octreotides, and diazoxide, were also used but were found to have varying levels of success depending on the individual patient. The study also highlighted that patients with chronic liver disease had significantly worse outcomes. While the overall recovery rate was 77%, those with liver disease were more likely to face complications or death, with the condition serving as a predictor of poor prognosis. This finding suggests that clinicians should be particularly cautious when treating patients with both liver disease and hypoglycaemia. Despite the systematic review providing new insights into the relationship between fibrous tumours and hypoglycaemia, the rarity of NICTH means that much remains unknown. The study emphasised the need for more extensive research, especially into the molecular mechanisms behind IGF-2 overproduction and its effects on blood sugar levels. The review concludes that early diagnosis and targeted treatments, including surgery, are key to improving patient outcomes. However, due to the limited number of large studies on this rare condition, healthcare providers may struggle to establish standardised care protocols for managing IGF-2-mediated hypoglycaemia.