title: Persistent hypoglycemia as an early, atypical presentation of hepatocellular carcinoma: A case report and systematic review of the literature.
abstract: The current study presents a case of persistent hypoglycemia as the initial manifestation of advanced hepatocellular carcinoma (HCC), as well as a systematic review of the management of hypoglycemia associated with HCC. A 42-year-old female presented with loss of consciousness and a blood glucose level of 30 mg/dl (normal range, 80-140 mg/dl). Abdominal ultrasound and computed tomography were performed to investigate tenderness in the right upper quadrant, and the results revealed a hepatic mass of 15 cm in diameter, with metastasis. A diagnosis of insulinoma was ruled out by examining the insulin level. Prednisolone treatment was ineffective for relieving the persistent hypoglycemia, however, a single dose of palliative radiotherapy reduced the hypoglycemic episodes to once monthly. Due to the advanced disease, the patient refused further treatment, with the exception of a palliative therapy with glucose fluid. The patient succumbed to pneumonia with sepsis. A systematic review of the literature indicated that steroids were the most commonly used drug for hypoglycemia associated with HCC, however, in the majority of cases no effect was noted as observed in this study. Cytoreduction by surgery or systemic chemotherapy has been the most effective treatment. Although rare, hypoglycemia may be the initial symptom of HCC. Cytoreduction is the most effective method of treating hypoglycemia associated with HCC.
authors.affiliation: Department of Family Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei 23561, Taiwan, R.O.C.
authors.forename: Chen-Yen
authors.initials: CY
authors.lastname: Tsai
authors.affiliation: Department of Family Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei 23561, Taiwan, R.O.C.
authors.forename: Shou-Chu
authors.initials: SC
authors.lastname: Chou
authors.affiliation: Department of Family Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei 23561, Taiwan, R.O.C. ; Graduate Institute of Clinical Medicine, Chang Gung University, Tao-Yuan 33302, Taiwan, R.O.C. ; Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan, R.O.C.
authors.forename: Hsien-Ta
authors.initials: HT
authors.lastname: Liu
authors.affiliation: Department of Endocrinology and Metabolism, Shuang Ho Hospital, Taipei Medical University, New Taipei 23561, Taiwan, R.O.C.
authors.forename: Jiunn-Diann
authors.initials: JD
authors.lastname: Lin
authors.affiliation: Department of Family Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei 23561, Taiwan, R.O.C. ; Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan, R.O.C.
authors.forename: Ying-Chin
authors.initials: YC
authors.lastname: Lin
keywords: hepatocellular carcinoma; hypoglycemia; review; signs and symptoms; steroids