Primary hepatocellular carcinoma with severe hypoglycemia: involvement of insulin-like growth factors.
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.
Yonei
Y
Y
Department of Internal Medicine, Nippon Kokan Hospital, Kanagawa, Japan.
Tanaka
M
M
Ozawa
Y
Y
Miyazaki
K
K
Tsukada
N
N
Inada
S
S
Inagaki
Y
Y
Miyamoto
K
K
Suzuki
O
O
Okawa
H
H
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
D007334:Insulin-Like Growth Factor I; D007335:Insulin-Like Growth Factor II