Non-islet cell tumor causing hypoglycemia: A paraneoplastic complication of hepatocellular carcinoma

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.