A Case of Hepatocellular Carcinoma Diagnosed with Resistant Hypoglycemia

Abstract

Background: There are many causes of the etiology of hypoglycemia. Hypoglycemia is very rare in individuals without diabetes. Although it can accompany islet cell malignancies such as insulinoma, it is much less common in solid organ tumors such as hepatocellular carcinoma as a component of paraneoplastic syndrome. Case Presentation: We present a 58-year-old male patient with no additional disease, who was examined for resistant hypoglycemia and was diagnosed as having hepatocellular carcinoma radiologically for the first time. Insulin level measured when serum glucose was 44 mg/dl: 0.4 µU/mL, c-peptide level: 0.355 ng/mL detected. Viral serology was found to be positive for HbsAg. In dynamic magnetic resonance imaging, showing continuity in segments 6 -7 and 8 in the right lobe, and also partially towards 5, heterogeneous hyperintense in T2 A's, diffusion-limiting, heterogeneous contrast enhancement in postcontrast series, cystic-necrotic in the center. The alpha-fetoprotein level was 60,500 ng/mL. Conclusion: Paraneoplastic hypoglycemia due to underlying malignancies should be considered in patients presenting with hypoglycemia.

Approach to Refractory Hypoglycaemia in a Patient with Hepatocellular Carcinoma: A Case Study and Literature Review

“…Epinephrine deficiency leads to primary autonomic nervous system failure and elevated dopamine which clinically manifest as orthostatic hypotension, ptosis, nasal congestion, exercise intolerance, and sexual disorders (Koren and Palladino, 2016). GH deficiency in adults may occur in 2 conditions: children ( Albayrak et al, 2022) with GH transitioning to adult and deficiency acquired during adulthood due to trauma or idiopathic. Symptoms of GH deficiency include low energy level, emotional lability, mental fatigue, decreased muscle mass, and decreased bone density (Pia et al, 2004;Gupta, 2011).…”