Hypoglycemia, an Atypical Early Sign of Hepatocellular Carcinoma
Tóm tắt
Hypoglycemia is extremely uncommon as the first presentation of hepatocellular carcinoma, and it occurs predominantly as a paraneoplastic manifestation. 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. 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 18F-fluoro-2-deoxy-D-glucose positron-emission tomography revealed a predominant uptake of glucose by the tumor mass. These findings indicate that hepatocellular carcinoma-associated hypoglycemia may be due exclusively to increased glucose utilization by the tumor mass.
Tài liệu tham khảo
World Health Organization. (2008). Mortality database. Available from: http://www.who.int/whosis/en
Montalto G, Cervello M, Giannitrapani L, Dantona F, Terranova A, Castagnetta LA. Epidemiology, risk factors, and natural history of hepatocellular carcinoma. Ann N Y Acad Sci. 2002;963:13–20.
Sherman M. Hepatocellular carcinoma: epidemiology, risk factors, and screening. Semin Liver Dis. 2005;25:143–54.
Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74–108.
Ross JS, Kurian S. Clear cell hepatocellular carcinoma: sudden death from severe hypoglycemia. Am J Gastroenterol. 1985;80:188–94.
Ndububa DA, Ojo OS, Adetiloye VA, Rotimi O, Durosinmi MA, Uchegbu LO. The incidence and characteristics of some paraneoplastic syndromes of hepatocellular carcinoma in Nigerian patients. Eur J Gastroenterol Hepatol. 1999;11:1401–4.
Chu CW, Hwang SJ, Luo JC, Tsay SH, Li CP, Chang FY, et al. Manifestation of hypercholesterolaemia, hypoglycemia, erythrocytosis and hypercalcaemia in patients with hepatocellular carcinoma: report of two cases. J Gastroenterol Hepatol. 1999;14:807–10.
Luo JC, Hwang SJ, Wu JC, Lai CR, Li CP, Chang FY, et al. Clinical characteristics and prognosis of hepatocellular carcinoma patients with paraneoplastic syndromes. Hepatogastroenterology. 2002;49:1315–9.
Saigal S, Nandeesh HP, Malhotra V, Sarin SK. A case of hepatocellular carcinoma associated with troublesome hypoglycemia: management by cytoreduction using percutaneous ethanol injection. Am J Gastroenterol. 1998;93:1380–1.
Nikeghbalian S, Bananzadeh A, Yarmoammadi H. Hypoglycemia, the first presenting sign of hepatocellular carcinoma. Saudi Med J. 2006;27:387–8.
McFadzean AJ, Yeung RTT. Hypoglycemia in primary carcinoma of the liver. Arch Intern Med. 1956;98:720–31.
McFadzean AJ, Yeung RTT. Further observations on hypoglycemia in hepatocellular carcinoma. Am J Med. 1969;47:220–35.
Yeung RTT. Hypoglycemia in hepatocellular carcinoma: a review. HKMJ. 1997;3:297–301.
Shapiro ET, Bell GI, Polonsky KS, Rubenstein AH, Kew MC, Tager HS. Tumor hypoglycemia: relationship to high molecular weight insulin-like growth factor II. J Clin Invest. 1990;85:1672–9.
Eastman RC, Carson RE, Orloff DG, Cochran CS, Perdue JF, Rechler MM, et al. Glucose utilization in a patient with hepatoma and hypoglycemia. Assessment by a positron emission tomography. J Clin Invest. 1992;89:1958–63.
Yonei Y, Tanaka M, Ozawa Y, Miyazaki K, Tsukada N, Inada S, et al. Primary hepatocellular carcinoma with severe hypoglycemia; involvement of insulin-like growth factors. Liver. 1992;12:90–3.
Yamaguchi M, Kamimura S, Takada J, Iwata K, Iida T, Kobayashi K, et al. Case report: insulin-like growth factors II expression in hepatocellular carcinoma with alcoholic liver fibrosis accompanied by hypoglycemia. J Gastroenterol Hepatol. 1998;13:47–51.
Ishida S, Noda M, Kuzuya N, Kubo F, Yamada S, Yamanaka T, et al. Big insulin-like growth factor II- producing hepatocellular carcinoma associated with hypoglicemia. Intern Med. 1995;34:1201–6.
Kahn CR. The riddle of tumor hypoglycemia revisited. Clin Endocrinol Metabol. 1980;95:505–17.
Daughaday WH, Emanuele MA, Brooks MH, Barbato AL, Kapadia M, Rotwein P. Synthesis and secretion of insulin-like growth factor II by a leiomyosarcoma with associated hypoglycemia. N Engl J Med. 1988;319:1434–40.
Thorgeirsson SS, Grishman JW. Molecular pathogenesis of human hepatocellular carcinoma. Nat Genet. 2002;31:339–46.
Aihara T, Noguchi S, Miyoshi Y, Nakano H, Sasaki Y, Nakamura Y, et al. Allelic imbalance of insulin-like growth factor II gene expression in cancerous and precancerous lesions of the liver. Hepatology. 1998;28:86–9.
August JT, Hiatt HH. Severe hypoglycemia secondary to a nonpancreatic fibrosarcoma with insulin activity. N Engl J Med. 1958;258:17–20.
Perkoff GT, Simons EL. Hypoglycemia in a patient with a fibrous tumor. Arch Intern Med. 1963;112:589–93.
Chowdhury F, Bleicher SJ. Studies of tumor hypglycemia. Metab Clin Exp. 1973;22:663–74.
Zapf J, Hauri C, Waldvogel M, Froesch ER. Acute metabolic effects and half-lives of intravenously administered insulinlike growth factors I and II in normal and hypophysectomised rats. J Clin Invest. 1986;77:1768–75.
Donaghy A, Ross R, Gimson A, Hughes SC, Holly J, Williams R. Growth hormone, insulin-like growth factor-I, and insulin-like growth factor binding proteins 1 and 3 in chronic liver disease. Hepatology. 1995;21:680–8.
Duffy MJ, Crown J. A personalized approach to cancer treatment: how biomarkers can help. Clin Chem. 2008;54:1170.