title: Hypoglycemia, an atypical early sign of hepatocellular carcinoma.
abstract: BACKGROUND
  Hypoglycemia is extremely uncommon as the first presentation of hepatocellular carcinoma, and it occurs predominantly as a paraneoplastic manifestation.
  
  
  METHODS
  We report a case of a 38-year-old-man positive for hepatitis B surface antigen with high-serum viremia who presented with symptoms of acute severe hypoglycemia.
  
  
  RESULTS
  Laboratory tests confirmed hypoglycemia (serum glucose 1.54 mmol/L) with undetectable serum-C peptide (<0.5 µIU/mL) and slightly increased serum insulin concentration (35 µIU/mL). Alpha-fetoprotein serum level was 75,625 ng/mL. Abdominal ultrasonography and computed tomography revealed a big vascularized mass of 13 cm in diameter occupying most of the right lobe of the liver and an (18)F-fluoro-2-deoxy-D-glucose positron-emission tomography revealed a predominant uptake of glucose by the tumor mass.
  
  
  CONCLUSIONS
  These findings indicate that hepatocellular carcinoma-associated hypoglycemia may be due exclusively to increased glucose utilization by the tumor mass.
authors.affiliation: 1st Internal Medicine Unit, University and Spedali Civili, Piazzale Spedali Civili 1, 25123 Brescia, Italy.
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Sorlini
authors.forename: Federica
authors.initials: F
authors.lastname: Benini
authors.forename: Primarosa
authors.initials: P
authors.lastname: Cravarezza
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Romanelli
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000378:metabolism; D005947:Glucose / Q000378:metabolism; D006509:Hepatitis B / Q000150:complications; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology*; D008113:Liver Neoplasms / Q000150:complications* / Q000378:metabolism; D008297:Male; D010257:Paraneoplastic Syndromes / Q000209:etiology* / Q000378:metabolism; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed
chemical_list: D005947:Glucose