title: Primary hepatocellular carcinoma with severe hypoglycemia: involvement of insulin-like growth factors.
abstract: We report a case of severe hypoglycemia and hepatic masses suspected to be an insulin-like growth factor-II (IGF-II)-producing hepatocellular carcinoma. A 62-year-old man presented with mental disorder in the night and early morning associated with extremely low blood sugar levels (less than 21 mg/dl). Computerized axial tomography and ultrasonography revealed a massive tumor in the right lobe of the liver with multiple secondary nodules, and a tumor thrombus in the portal vein. At autopsy 107 days after admission, the liver weighed 3070 g, histologically showing an Edmondson type II tumor with liver cirrhosis. IGF-II in plasma (899 ng/ml) and tumor tissue (2.4 micrograms/g) was higher than that in normal plasma (374-804 ng/ml) and non-tumor liver tissue (0.2 micrograms/ml), while IGF-I (14 ng/ml) was significantly reduced. IGF-II, probably produced by the liver tumor, appeared to be involved in the mechanism of hypoglycemia.
authors.affiliation: Department of Internal Medicine, Nippon Kokan Hospital, Kanagawa, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Yonei
authors.forename: M
authors.initials: M
authors.lastname: Tanaka
authors.forename: Y
authors.initials: Y
authors.lastname: Ozawa
authors.forename: K
authors.initials: K
authors.lastname: Miyazaki
authors.forename: N
authors.initials: N
authors.lastname: Tsukada
authors.forename: S
authors.initials: S
authors.lastname: Inada
authors.forename: Y
authors.initials: Y
authors.lastname: Inagaki
authors.forename: K
authors.initials: K
authors.lastname: Miyamoto
authors.forename: O
authors.initials: O
authors.lastname: Suzuki
authors.forename: H
authors.initials: H
authors.lastname: Okawa
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000737:chemistry / Q000150:complications*; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology*; D007334:Insulin-Like Growth Factor I / Q000032:analysis*; D007335:Insulin-Like Growth Factor II / Q000032:analysis*; D008113:Liver Neoplasms / Q000097:blood / Q000737:chemistry / Q000150:complications*; D008297:Male; D008875:Middle Aged
chemical_list: D007334:Insulin-Like Growth Factor I; D007335:Insulin-Like Growth Factor II