Non-Islet Cell tumor hypoglycemia is caused by benign or malignant tumors, especially mesenchymal- or epithelial-derived tumors. In our patient, we have no pathological diagnosis of hepatocellular carcinoma but we use radiological diagnostic criteria as well-known international recommendation (3, 4). Moreover the history of long standing hepatitis B viral infection confirmed the diagnosis of hepatitis B induced hepatocellular carcinoma.
Our patient presented with hypoglycemic adrenergic symptoms with low plasma glucose (below 55 milligrams/deciliter) which were disappeared after rise up plasma glucose, compatible with Whipple’s triads (5). Hypoglycemia in non-diabetic patients was found uncommonly, so it needs to evaluation of the cause. Plasma insulin and plasma c-peptide levels were low while we had no data of plasma glucose level at the same time due to missing data from the primary hospital. However the decrease in endogenous insulin secretion is the first physiologic response of hypoglycemia that occurs as plasma glucose concentrations decline (6). It means that hypoglycemia of our patient is caused by insulin-like growth factors or other non-insulin mediated hypoglycemia (5). Even through, we did not demonstrate insulin-like growth factors in serum or tumor, the resolution of hypoglycemia after TACE was confirmed that our patient had NIICH associated with HCC .
Other cause of hypoglycemia in hepatocellular carcinoma is adrenal insufficiency from bilateral adrenal metastasis. Consider with corticotropin stimulation test and CT scan of upper abdomen, there were no evidences of adrenal insufficiency or adrenal metastasis.
NICTH associated with HCC is infrequently found in clinical practice. There were a number of case reports to control hypoglycemia in NICTH associated with HCC based on two treatment strategies, tumor reduction or symptomatic treatment. For...