Paraneoplastic Hypoglycemia in Hepatocarcinoma: Case Report and Literature Review

Regino, Carlos A; Lopez-Montoya, Vanessa; López-Urbano, Fernado; Álvarez, José Carlos Pena; Román-Gonzaléz, Alejandro

doi:10.7759/cureus.12013

Cited by 10 publications

(10 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Section: Discussionmentioning

confidence: 99%

“…[7] NIPH can be divided into interstitial and epithelial tissue tumors according to their tissue of origin, with hepatocellular carcinoma most common, accounting for 23% of NIPH, and 4% to 27% of patients with hepatocellular carcinoma having hypoglycemia. [8] All 3 types of nondiabetic hypoglycemia meet the clinical characteristic criteria of the Whipple triad for hypoglycemic symptoms. Insulinoma and NIPH often occur at night and on an empty stomach.…”

Section: Discussionmentioning

confidence: 99%

“…Type A usually occurs in the terminal stage and is due to tumor occupation of normal liver, resulting in disorders of glycogen synthesis, decomposition, glycolysis, and gluconeogenesis in the liver, as well as the inability to produce glucose that satisfies tumor consumption. [8] The patient in case 2 is likely to be type A NIPH. Type B occurs in the early stage of liver disease and is due to the excessive secretion of big-insulin-like growth factor II (big-IGF-II) by tumor tissues.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

A review on nondiabetic hypoglycemia from various causes: Case series report

Gan,

Zhu,

Gao

et al. 2023

Medicine

View full text Add to dashboard Cite

Rationale: Hypoglycemia is common in patients with glucose regulation disorders and related diabetic treatments but is rare in nondiabetic patients. Severe hypoglycemia can cause harm to patients’ cognition, consciousness, central nervous system, cardiovascular and cerebrovascular system, and even death. However, the most fundamental way to control hypoglycemia is to identify the cause and deal with the primary disease. This article introduces 3 cases of nondiabetic hypoglycemia with different causes, aiming to improve our understanding of nondiabetic hypoglycemia and improve the ability of early diagnosis and differential diagnosis. Patient concerns: Case 1 is a 19-year-old female with a history of recurrent coma, and magnetic resonance imaging and endoscopic ultrasound of the pancreas suggest insulinoma. Case 2 is a 74-year-old male with a history of viral hepatitis, and computerized tomography shows multiple nodules in the liver, which is diagnosed as liver cancer. Case 3 is a 39-year-old female with a history of taking methimazole, who tested positive for insulin antibodies, and was diagnosed with insulin autoimmune syndrome. Diagnosis: All 3 patients were diagnosed with nondiabetic hypoglycemia, but the causes varied, and included insulinoma, non-islet cell tumor-induced hypoglycemia, and insulin autoimmune syndrome. Interventions: Case 1 underwent pancreatic tail resection; case 2 refused anti-tumor treatment and received glucose injections for palliative treatment only; and case 3 stopped taking methimazole. Outcomes: After surgery, the blood sugar in case 1 returned to normal, and the blood sugar in case 2 was maintained at about 6.0 mmol/L. The symptoms of hypoglycemia gradually improved in case 3 after stopping the medication. Lessons: Non-diabetic hypoglycemia requires further examination to clarify the cause, and the correct differential diagnosis can provide timely and effective treatment, improving the patient’s prognosis.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A review on nondiabetic hypoglycemia from various causes: Case series report

Gan,

Zhu,

Gao

et al. 2023

Medicine

View full text Add to dashboard Cite

show abstract

“…Patients with HCC may experience hypoglycemia due to a syndrome known as non-islet cell tumor hypoglycemia. This syndrome is characterized by decreased serum levels of insulin, C-peptide, and beta-hydroxybutyrate, along with increased levels of IGF-2 and the IGF-2/IGF-1 ratio[ 29 - 31 ] (Figure 1B ).…”

Section: Pathophysiologymentioning

confidence: 99%

From liver to hormones: The endocrine consequences of cirrhosis

Quiroz-Aldave,

Gamarra-Osorio,

Durand-Vásquez

et al. 2024

World J Gastroenterol

View full text Add to dashboard Cite

Hepatocrinology explores the intricate relationship between liver function and the endocrine system. Chronic liver diseases such as liver cirrhosis can cause endocrine disorders due to toxin accumulation and protein synthesis disruption. Despite its importance, assessing endocrine issues in cirrhotic patients is frequently neglected. This article provides a comprehensive review of the epidemiology, pathophysiology, diagnosis, and treatment of endocrine disturbances in liver cirrhosis. The review was conducted using the PubMed/Medline, EMBASE, and Scielo databases, encompassing 172 articles. Liver cirrhosis is associated with endocrine disturbances, including diabetes, hypoglycemia, sarcopenia, thyroid dysfunction, hypogonadotropic hypogonadism, bone disease, adrenal insufficiency, growth hormone dysfunction, and secondary hyperaldosteronism. The optimal tools for diagnosing diabetes and detecting hypoglycemia are the oral glucose tolerance test and continuous glucose monitoring system, respectively. Sarcopenia can be assessed through imaging and functional tests, while other endocrine disorders are evaluated using hormonal assays and imaging studies. Treatment options include metformin, glucagon-like peptide-1 analogs, sodium-glucose co-transporter-2 inhibitors, and insulin, which are effective and safe for diabetes control. Established standards are followed for managing hypoglycemia, and hormone replacement therapy is often necessary for other endocrine dysfunctions. Liver transplantation can address some of these problems.

show abstract

“…These paraneoplastic syndromes typically arise from the body's reaction to the tumor's abnormal metabolism or the release of the bioactive molecules produced by the tumor [11]. PNS manifests in approximately 16.8% to 43.6% of individuals diagnosed with HCC [5,[12][13][14] and has been correlated with accelerated tumor advancement, the development of sizable tumors, the occurrence of multiple tumors within the liver, elevated serum levels of alpha-fetoprotein (AFP), and the invasion of HCC into the portal vein [8].…”

Section: Introductionmentioning

confidence: 99%

Paraneoplastic Syndromes in Hepatocellular Carcinoma, Epidemiology, and Survival: A Retrospective Seven Years Study

Burciu,

Sirli,

Bende

et al. 2024

Medicina

View full text Add to dashboard Cite

Background and Objectives: Liver cancer poses a significant global health threat, ranking among the top three causes of cancer-related deaths. Patients with hepatocellular carcinoma (HCC) often present with symptoms associated with neoplasms or unusual clinical features such as paraneoplastic syndromes (PNS), including hypoglycemia, hypercholesterolemia, thrombocytosis, and erythrocytosis. Our study aimed to investigate the prevalence, clinical characteristics, and survival outcomes associated with PNS in HCC patients and assess each PNS’s impact on patient survival. Materials and Methods: We conducted a retrospective analysis of PNS clinical features and survival among consecutive HCC patients diagnosed at our department over seven years, comparing them with HCC patients without PNS. The study involved a retrospective data evaluation from 378 patients diagnosed with HCC between January 2016 and October 2023. Results: We obtained a PNS prevalence of 25.7%, with paraneoplastic hypercholesterolemia at 10.9%, hypoglycemia at 6.9%, erythrocytosis at 4.5%, and thrombocytosis at 3.4%. Patients with PNS tended to be younger and predominantly male. Multivariate analysis revealed a strong correlation between PNS and levels of alpha-fetoprotein and tumor size, with diabetes also showing a significant statistical association (p < 0.05). Subgroup analysis based on specific paraneoplastic syndromes demonstrated shorter survival in patients with PNS, albeit without significant statistical differences, except for hypoglycemia (p < 0.0001). Matched analysis indicated a shorter survival rate for patients with PNS, although no significant statistical differences were observed. Conclusions: PNS are frequently observed in HCC cases and are associated with unfavorable prognoses and decreased survival rates due to their correlation with increased tumor burdens. However, they do not independently predict poor survival. The impact of individual PNS on HCC prognosis varies.

show abstract

Paraneoplastic Hypoglycemia in Hepatocarcinoma: Case Report and Literature Review

Cited by 10 publications

References 18 publications

A review on nondiabetic hypoglycemia from various causes: Case series report

A review on nondiabetic hypoglycemia from various causes: Case series report

From liver to hormones: The endocrine consequences of cirrhosis

Paraneoplastic Syndromes in Hepatocellular Carcinoma, Epidemiology, and Survival: A Retrospective Seven Years Study

Contact Info

Product

Resources

About