Primary hepatocellular carcinoma with severe hypoglycemia; involvement of insulin‐like growth factors

Yasuda, Yoshikazu; Tanaka, Mizuko; Ozawa, Yuji; Miyazaki, Kuratoshi; Tsukada, Nobuhiro; Inada, Shinya; Inagaki, Y; Miyamoto, Kei; Сузукі, Осаму; Okawa, Hitoshi

doi:10.1111/j.1600-0676.1992.tb00563.x

Cited by 18 publications

(8 citation statements)

References 11 publications

(17 reference statements)

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“…Cytoreduction by surgical removal of the tumor resulted in resolution of the hypoglycemia in one case (12), while percutaneous ethanol injection of the tumor resulted in the resolution of the hypoglycemia in another case (1). Furthermore, systemic chemotherapy resulted in a transient resolution in one case (9). …”

Section: Discussionmentioning

confidence: 99%

Persistent hypoglycemia as an early, atypical presentation of hepatocellular carcinoma: A case report and systematic review of the literature

et al. 2014

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The current study presents a case of persistent hypoglycemia as the initial manifestation of advanced hepatocellular carcinoma (HCC), as well as a systematic review of the management of hypoglycemia associated with HCC. A 42-year-old female presented with loss of consciousness and a blood glucose level of 30 mg/dl (normal range, 80–140 mg/dl). Abdominal ultrasound and computed tomography were performed to investigate tenderness in the right upper quadrant, and the results revealed a hepatic mass of 15 cm in diameter, with metastasis. A diagnosis of insulinoma was ruled out by examining the insulin level. Prednisolone treatment was ineffective for relieving the persistent hypoglycemia, however, a single dose of palliative radiotherapy reduced the hypoglycemic episodes to once monthly. Due to the advanced disease, the patient refused further treatment, with the exception of a palliative therapy with glucose fluid. The patient succumbed to pneumonia with sepsis. A systematic review of the literature indicated that steroids were the most commonly used drug for hypoglycemia associated with HCC, however, in the majority of cases no effect was noted as observed in this study. Cytoreduction by surgery or systemic chemotherapy has been the most effective treatment. Although rare, hypoglycemia may be the initial symptom of HCC. Cytoreduction is the most effective method of treating hypoglycemia associated with HCC.

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Section: Discussionmentioning

confidence: 99%

Persistent hypoglycemia as an early, atypical presentation of hepatocellular carcinoma: A case report and systematic review of the literature

et al. 2014

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“…IGF-2 might be falsely normal in our patient because the sample was collected after the first dose of prednisolone was administered, which was able to inhibit the production of IGF-2[ 22 ]. In addition, serum IGF-2 levels in NICTH are often not elevated partially because most “big IGF-2” are not measured by common commercially available assay[ 16 , 23 , 24 ]. It has also been found by a few case reports that the levels of serum IGF-2 were decreased or normal in contrast to an increased pro-IGF-2 in NICTH[ 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

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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“…In humans, HCC has been associated with increased insulin‐like growth factor (IGF), 18 PTHrp, 3 and thrombopoietin 5 . Hyperthyroxinemia, hypercholesterolemia, hypertriglyceridemia, and mild hyperalbuminemia have been reported in a single adolescent with HCC 4 .…”

Section: Discussionmentioning

confidence: 99%

Hyperalbuminemia associated with hepatocellular carcinoma in a dog

Wellman

Carsillo

2009

Veterinary Clinical Pathol

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A 12-year-old, neutered male, mixed-breed dog was presented to The Ohio State University Veterinary Teaching Hospital with a history of weight loss and weakness. Laboratory abnormalities reported by the referring veterinarian during the past year included increased alkaline phosphatase (ALP) activity, hyperalbuminemia, and nonregenerative anemia. On referral, the dog appeared hydrated and had moderate muscle wasting and hepatomegaly. A large lobular hepatic mass was observed ultrasonographically. Laboratory results included mild to moderate nonregenerative anemia, urine-specific gravity of 1.035, 3+ proteinuria, increased serum activities of alanine aminotransferase (229 U/L, reference interval 10-55 U/L), ALP (813 U/L, reference interval 15-120 U/L), and the steroid-induced isoform of ALP (676 U/L, reference interval 0-6 U/L), marked hyperalbuminemia (5.3 g/dL, reference interval 2.9-4.2 g/dL), and an increased A/G ratio (1.7). Hyperalbuminemia was confirmed by reanalysis on 2 different analyzers and by agarose gel electrophoresis, and colloid osmotic pressure (COP) was markedly increased (42.5 mmHg, reference interval 20-25 mmHg). Cytologic examination of a fine-needle aspirate of the hepatic mass indicated hepatocellular proliferation; histologic examination of an excisional biopsy confirmed hepatocellular carcinoma. Three weeks after surgery, the albumin concentration, A/G ratio, COP, and ALT activity had normalized, but ALP activities remained high. We hypothesized that hyperalbuminemia developed secondary to hepatocellular carcinoma due to increased synthesis of albumin by malignant hepatocytes or due to decreased negative feedback from impaired hepatocellular osmoreceptivity. Hepatocellular carcinoma has been associated with paraneoplastic secretion of other proteins, but hyperalbuminemia has been reported only once in a human patient and has not previously in dogs.

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Primary hepatocellular carcinoma with severe hypoglycemia; involvement of insulin‐like growth factors

Cited by 18 publications

References 11 publications

Persistent hypoglycemia as an early, atypical presentation of hepatocellular carcinoma: A case report and systematic review of the literature

Persistent hypoglycemia as an early, atypical presentation of hepatocellular carcinoma: A case report and systematic review of the literature

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

Hyperalbuminemia associated with hepatocellular carcinoma in a dog

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