IGF2 and neoplasm: Nonislet cell tumor hypoglycemia (NICTH) is a paraneoplastic syndrome characterized by recurrent fasting hypoglycemia, which is thought to be caused by the excessive secretion of incompletely processed precursors of insulin-like growth factor (IGF)-II (high molecular weight IGF-II or big IGF-II) by the tumor into the circulation.1–3 IGF-II-induced NICTH typically occurs in patients with large slow-growing neoplasm.