Non-Islet Cell Tumor Hypoglycemia (NICTH) is rare with four times less often than that of insulinoma in clinical practice. It is a paraneoplastic syndrome harboring in terminal ill cancerous patients. It was first described in 1929 in a patient with metastatic hepatocellular carcinoma. In most cases, NICTH occurs in patients with solid tumors of mesenchymal and epithelial origins such as mesothelioma in pleura, gastric carcinoma in general but hepatocellular carcinoma particularly in Taiwan. In NICTH, the serum levels of insulin, C-peptide, and IGF-1 are usually lower or undetectable. On the other hand, the circulating levels of total IGF2 may be increased, decreased, or normal.
　　There are five possible mechanisms for this syndrome: (1) cancer cells secrete Insulin-like growth factor II or insulin, (2) The local effects of the tumor in hepatic parenchyma play an important role to decrease glycogenesis, (3) prolongation the half-life of insulin metabolism, (4) increased utilization of glucose by the tumor, and (5). The function of gastrointestinal glucose absorption mitigated. An IGF-2: IGF-1 ratio of >10 is considered to be clinically significant and highly suggestive of NICTH.
　　Hypoglycemia in NICTH can be managed by administration of oral glucose, intravenous dextrose or glucagon. In some cases, Diazoxide, a potent inhibitor of insulin secretion, has been found to be useful. Diazoxide directly inhibits the release of insulin through stimulation of adrenergic receptors and also has an extra pancreatic hyperglycemic effect, probably by inhibiting c-AMP phosphodiesterase, resulting in higher plasma levels of cyclic AMP and enhanced glycogenolysis.
　　However, Diazoxide sometimes did not prevent his hypoglycemic episodes, so glucocorticoid was considered as an alternative for his condition. Glucocorticoid therapy has been shown to suppress IGF-2 in a dose dependent manner and also by increasing gluconeogenesis. Surgical resection of the tumor whenever possible is the treatment of choice followed by radiotherapy and chemotherapy for inoperable disease and if successful, usually results in resolution of hypoglycemia.
　　In conclusion, the prognosis of cancerous subjects with hypoglycemia is variable and answering the emergency consultation call in oncology ward with hypoglycemia, paraneoplastic syndrome should be considered first, proved until to be otherwise.