Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 27, 2020; 12(8): 519-524
Published online Aug 27, 2020. doi: 10.4254/wjh.v12.i8.519
Non-islet cell tumor hypoglycemia as an initial presentation of hepatocellular carcinoma coupled with end-stage liver cirrhosis: A case report and review of literature
Bo Yu, Rana Douli, Jose Amaya Suarez, Victor Perez Gutierrez, Mohammad Aldiabat, Maria Khan
Bo Yu, Rana Douli, Jose Amaya Suarez, Victor Perez Gutierrez, Mohammad Aldiabat, Maria Khan, Department of Medicine, Lincoln Medical Center, Bronx, NY 10451-5504, United States
Author contributions: Yu B wrote the manuscript; Douli R, Suarez JA reviewed the paper; Gutierrez VP edited the references; Aldiabat M and Khan M designed the figures.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Bo Yu, MD, MSc, Doctor, Department of Medicine, Lincoln Medical Center, 234 E.149th Street, Bronx, NY 10451-5504, United States.
Received: March 31, 2020
Peer-review started: March 31, 2020
First decision: July 5, 2020
Revised: July 8, 2020
Accepted: July 26, 2020
Article in press: July 26, 2020
Published online: August 27, 2020
Core Tip

Core tip: Paraneoplastic Non-islet cell tumor hypoglycemia can occur as an initial presentation in patients with hepatocellular carcinoma and is often difficult to correct. It is tend to be underdiagnosed because patients often developed tolerance to chronic fasting hypoglycemia secondary to advanced liver cirrhosis. A ratio of insulin-like growth factor-2/insulin-like growth factor-1 above 10 is often found if non-islet cell tumor hypoglycemia is induced by overproduction of incompletely processed insulin-like growth factor-2. Oral corticosteroids and frequent high carbohydrate meals are often recommended but the outcome is unfavorable in general if tumor removal is not possible.