Hypoglycemia, an atypical early sign of hepatocellular carcinoma

Background: Hypoglycemia is extremely uncommon as the first presentation of hepatocellular carcinoma, and it occurs predominantly as a paraneoplastic manifestation.
Methods: We report a case of a 38-year-old-man positive for hepatitis B surface antigen with high-serum viremia who presented with symptoms of acute severe hypoglycemia.
Results: Laboratory tests confirmed hypoglycemia (serum glucose 1.54 mmol/L) with undetectable serum-C peptide (<0.5 µIU/mL) and slightly increased serum insulin concentration (35 µIU/mL). Alpha-fetoprotein serum level was 75,625 ng/mL. Abdominal ultrasonography and computed tomography revealed a big vascularized mass of 13 cm in diameter occupying most of the right lobe of the liver and an (18)F-fluoro-2-deoxy-D-glucose positron-emission tomography revealed a predominant uptake of glucose by the tumor mass.
Conclusions: These findings indicate that hepatocellular carcinoma-associated hypoglycemia may be due exclusively to increased glucose utilization by the tumor mass.