IGF-II-secreting bladder tumour presenting as a fall in a 91-year-old

Unexplained and recurrent episodes of hypoglycaemia should raise clinical suspicion of a paraneoplastic process that requires further investigation. It is important to maintain a broad range of differentials when approaching a frail patient with recurrent hypoglycaemia. Management should be guided by discussion with a multidisciplinary team and patient preference. IGF-II-secreting tumours are widely associated with mesenchymal tumours; however, this case presents a rare possible association with bladder tumours. Surgical resection of NICTH tumours is the mainstay of treatment, but when it is not feasible, other medical management should be explored.