Recurrent hypoglycemia in a patient with advanced Hepatocellular Carcinoma

Background: Nonislet cell tumor hypoglycemia (NICTH) is a rare but serious complication of malignancy. Various causes of this type of hypoglycemia include excessive tumor burden resulting in destruction of the liver or adrenal glands, production of autoantibodies against insulin and tumoral production of incompletely processed IGF-2. Objectives: Objective of this case report is to explore pathogenic mechanisms for hypoglycemia in hepatocellular carcinoma (HCC), and evidence-based treatment options. Methods: We present a case of recurrent symptomatic hypoglycemia, despite conservative management, in a patient with extensive hepatocellular carcinoma. Results: Patient developed recurrent hypoglycemia despite attempting treatment with therapies based on limited evidence available on literature review. Conclusion: Management of hypoglycemia is usually challenging given patients are usually not good candidates for aggressive therapies given advanced cancer stage and/or poor general condition. Paraneoplastic hypoglycemia is usually a poor prognostic indicator. Experimental treatment options for hypoglycemia include steroids, glucagon and growth hormone.