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Case Report
Non-islet cell tumor causing hypoglycemia: A paraneoplastic complication of hepatocellular carcinoma
1 Department of Internal Medicine, The Brooklyn Hospital Center, 121 Dekalb Avenue, Brooklyn, NY 11201, USA
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Samridhi Sinha
DO, Department of Internal Medicine, The Brooklyn Hospital Center, 121 Dekalb Avenue, Brooklyn, NY 11201,
USA
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Article ID: 100125Z10SS2023
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Sinha S, Ahluwalia A, Wasserman C. Non-islet cell tumor causing hypoglycemia: A paraneoplastic complication of hepatocellular carcinoma. J Case Rep Images Oncology 2023;9(2):15–18.ABSTRACT
Introduction: Hypoglycemia is a common complication in patients with diabetes who are using either insulin or oral hypoglycemic agents. In non-diabetic patient hypoglycemia is more rare and paraneoplastic syndrome should be considered if other causes have been excluded. Hepatocellular cancer is an example of a non-islet cell tumor that can cause hypoglycemia.
Case Report: Here we present a case of a 71-year-old male with history of metastatic hepatocellular cancer, treated hepatitis C infection, and human immunodeficiency virus (HIV). The patient was on active treatment with nivolumab. During admission he developed multiple episodes of hypoglycemia. The tests revealed decreased C-peptide and insulin levels suggesting non-islet cell etiology. The patient was initially treated with glucagon, and then started on steroids thereafter his episodes of hypoglycemia resolved. He continued to have stable disease while on immunotherapy, as well as no further hypoglycemia events while remaining on long term steroids.
Conclusion: This case illustrates an important example of non-islet cell tumor hypoglycemia in a patient with hepatocellular carcinoma (HCC) where immunotherapy is emerging as a promising treatment option and the use of steroids can interfere with treatment. In situations where tumor resection, debulking, or ablation cannot be done, treatment of choice is glucagon for acute episodes and steroids can be considered for long-term management.
Keywords: Big IGF-2, Non-islet cell tumor causing hypoglycemia, Paraneoplastic
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Author Contributions
Samridhi Sinha - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Amith Ahluwalia - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Carrie Wasserman - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2023 Samridhi Sinha et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
