Hypoglycaemia presenting as sole manifestation of hepatocellular carcinoma

Jha, Vijoy Kumar; Borpujari, PJ

doi:10.1016/s0377-1237(11)60113-5

Medical Journal Armed Forces India

2012

DOI: 10.1016/s0377-1237(11)60113-5

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Hypoglycaemia presenting as sole manifestation of hepatocellular carcinoma

Vijoy Kumar Jha

PJ Borpujari

Abstract: oxaloacetic transaminase-124 IU/L, serum glutamic pyruvic transaminase-164 IU/L, serum alkaline phosphatase-130 IU/L, serum albumin-3.5 g/dL, serum cholesterol-245 mg/dL, triglycerides-135 mg/dL, low-density lipoprotein-168 mg/dL, prothrombin time international normalised ratio 1.4, S. Ca ++ -9 mg/dL, haemoglobin A 1C -5.2%, serum cortisol-18.34 μg/dL (6.2-19.4), serum insulin-21 IU/mL (3-35), serum C peptide-3.6 ng/mL (F-1.1-4.4, stimulated-3.3-13.2), insulin-like growth factor-II in plasma-892 ng/mL (374-804… Show more

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Cited by 3 publications

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Resolution of Cardiac Symptoms through Preoperative Intravenous Iron Supplementation in a Cancer Patient

Nawratil¹,

Berger²,

Geisberger³

2019

CRCM

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Cardiologic assessment was conducted on a 78-year-old male patient scheduled for elective aortic valve surgery who complained of angina and dyspnea that had arisen over the previous few months. Evaluation showed stable coronary artery disease and iron deficiency anemia (hemoglobin, 7.7 g/dL). Colonoscopy revealed a non-stenosing carcinoma of the right colonic flexure that was causing chronic blood loss. The interdisciplinary tumor board of the hospital decided that his need for an extended right hemicolectomy followed by resection of two pulmonary nodules that were suspicious of metastatic lesions had priority over his cardiac surgery. Prior to abdominal surgery, the patient received 4 × 500 mg intravenous iron (Ferric-Carboxymaltose) over 2 weeks, for correction of iron deficiency and optimization of hemoglobin concentration. This treatment led to rapid improvement of his angina and exertion-induced dyspnea. His hemoglobin concentration continued to rise even after completion of the iron supplementation, and reached normal levels before thoracoscopic removal of the lung nodules, which took place 1 month after resection of the colon tumor. The patient remained in good clinical condition without any need for blood transfusions. As follow-up visits showed persistent abatement of angina and dyspnea, aortic valve surgery and other cardiac interventions were no longer deemed necessary.

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Resolution of Cardiac Symptoms through Preoperative Intravenous Iron Supplementation in a Cancer Patient

Nawratil¹,

Berger²,

Geisberger³

2019

CRCM

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Recurrent Hypoglycaemia in a Diabetic Patient Presented a Gastric Cancer: Think about Paraneoplastic Syndrome

Randriamalala¹,

Tika²,

Ranaivomanana³

et al. 2019

CRCM

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Non-islet cell tumor hypoglycemia as an initial presentation of hepatocellular carcinoma coupled with end-stage liver cirrhosis: A case report and review of literature

Douli

Suarez

et al. 2020

WJH

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BACKGROUND Non-islet cell tumor hypoglycemia (NICTH) is a rare cause of persistent hypoglycemia seen in patients with hepatocellular carcinoma (HCC). It is likely to be underdiagnosed especially in the patients with poor hepatic function and malnutrition. Herein, we report a rare case of NICTH as the initial presentation of HCC in a patient with chronic hypoglycemia due to end-stage liver cirrhosis. CASE SUMMARY A 62-year-old male with chronic fasting hypoglycemia secondary to end-stage hepatitis C-related cirrhosis, presented with altered mental status and dizziness. He was found to have severe hypoglycemia refractory to glucose supplements. Imaging studies and biopsy discovered well differentiated HCC without metastasis. Further evaluation showed low insulin, C-peptide and beta-hydroxybutyrate along with a high insulin-like growth factor-2/insulin-like growth factor ratio, consistent with the diagnosis of NICTH. As patient was not a candidate for surgical resection or chemotherapy, he was started on prednisolone with some improvements in the glucose homeostasis, but soon decompensated after a superimposed hospital acquired pneumonia. CONCLUSION NICTH can occur as the sole initial presentation of HCC and is often difficult to correct without tumor removal. Clinicians should maintain high clinical suspicion for early recognition of paraneoplastic NICTH in patients at risk for HCC, even those with chronic fasting hypoglycemia in the setting of severe hepatic failure and malnutrition.

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Hypoglycaemia presenting as sole manifestation of hepatocellular carcinoma

Cited by 3 publications

References 6 publications

Resolution of Cardiac Symptoms through Preoperative Intravenous Iron Supplementation in a Cancer Patient

Resolution of Cardiac Symptoms through Preoperative Intravenous Iron Supplementation in a Cancer Patient

Recurrent Hypoglycaemia in a Diabetic Patient Presented a Gastric Cancer: Think about Paraneoplastic Syndrome

Non-islet cell tumor hypoglycemia as an initial presentation of hepatocellular carcinoma coupled with end-stage liver cirrhosis: A case report and review of literature

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