Hypoglycemia, an atypical early sign of hepatocellular carcinoma.
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.
Sorlini
Marialuisa
M
1st Internal Medicine Unit, University and Spedali Civili, Piazzale Spedali Civili 1, 25123 Brescia, Italy.
Benini
Federica
F
Cravarezza
Primarosa
P
Romanelli
Giuseppe
G
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
D005947:Glucose