title: Manifestations of hypercholesterolaemia, hypoglycaemia, erythrocytosis and hypercalcaemia in patients with hepatocellular carcinoma: report of two cases.
abstract: BACKGROUND
  Hypercholesterolaemia, hypoglycaemia, hypercalcaemia and erythrocytosis, are well-known paraneoplastic manifestations in patients with hepatocellular carcinoma (HCC). Hepatocellular carcinoma patients manifesting with two or three paraneoplastic manifestations have been previously reported. However, HCC patients presenting with four paraneoplastic syndromes have not been previously reported.
  
  
  RESULTS
  This manuscript describes two HCC patients who manifested with hypercholesterolaemia, hypoglycaemia, hypercalcaemia and erythrocytosis during their clinical course. Erythrocytosis appeared early when HCC was diagnosed and declined to within normal range after optimal therapy for HCC. Hypercholesterolaemia manifested initially after the diagnosis in case 1, declined to within normal range after lobectomy and was re-elevated after tumour recurred. With disease progression, hypercalcaemia and hypoglycaemia occurred 1-3 months after diagnosis and the both patients subsequently died several days later.
  
  
  CONCLUSIONS
  Similar features found in both patients were large tumour burden, high serum alpha-fetoprotein level and rapid downhill clinical course even with optimal therapy. The clinical significance of these paraneoplastic manifestations is discussed.
authors.affiliation: Department of Medicine, Veterans General Hospital-Taipei and National Yang-Ming University School of Medicine, Taiwan.
authors.forename: C W
authors.initials: CW
authors.lastname: Chu
authors.forename: S J
authors.initials: SJ
authors.lastname: Hwang
authors.forename: J C
authors.initials: JC
authors.lastname: Luo
authors.forename: S H
authors.initials: SH
authors.lastname: Tsay
authors.forename: C P
authors.initials: CP
authors.lastname: Li
authors.forename: F Y
authors.initials: FY
authors.lastname: Chang
authors.forename: S D
authors.initials: SD
authors.lastname: Lee
authors.forename: W Y
authors.initials: WY
authors.lastname: Lui
authors.forename: J H
authors.initials: JH
authors.lastname: Chiang
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology*; D006937:Hypercholesterolemia / Q000209:etiology*; D007003:Hypoglycemia / Q000209:etiology*; D008113:Liver Neoplasms / Q000150:complications* / Q000175:diagnosis; D008297:Male; D010257:Paraneoplastic Syndromes / Q000175:diagnosis*; D011086:Polycythemia / Q000209:etiology*