Introduction:
A rare case of persistent hypoglycemia as a paraneoplastic manifestation of an adrenal tumor due to excessive secretion of IGF2 is being reported.

Aim:
To learn about rare causes of hypoglycemia.

Case study:
Hypoglycemia is most commonly due to antidiabetic drugs. However, it is not always drug induced and it can be observed in other conditions unrelated to diabetes, such as insulinoma, autoimmune disorders, and neoplasia. Herein, we report the case of a rare cause of severe and recurrent hypoglycemia in a 83-year-old diabetic and hypertensive lady who was subsequently diagnosed with adrenal malignancy and hypoglycemia was found to be a paraneoplastic manifestation of the tumor secreting IGF2.

Results and discussion:
Although more than 95% of cases of hypoglycemia are due antidiabetic drugs but there are other rare causes of hypoglycemia – malignancy being the most important in the rare causes of hypoglycemia. Persistent hypoglycemia should arouse a suspicion of a rare cause of hypoglycemia. In our case hypoglycemia was due to excessive secretion of IGF2 by the adrenal tumor. Several such case cases have been reported where hypoglycemia was a paraneoplastic manifestation of the tumor. So, we need to be aware of the rare causes of hypoglycemia as it can lead to the diagnosis of the primary tumor, as has been in our case, and it can also significantly affect the course of the treatment.

Conclusions:
IFG2 secreting tumor can be a rare cause of hypoglycemia.