Recurrent hypoglycemic coma as the initial and single clinical manifestation of advanced hepatocellular carcinoma.

The association between hypoglycemia and non-pancreatic tumors has been widely reported [1, 2]. As a well-known complication of tumor, hypoglycemia occurs by several mechanisms such as overproduction of insulin-like growth factor II (IGF-II) [3, 4] and increased glucose utilization by the tumor [5]. Most common cancers causing non-islet cell tumor hypoglycemia (NICTH) are tumors of the gastrointestinal tract, lungs, pancreas, adrenal, and ovary [6]. Hepatocellular carcinoma (HCC) is the primary cancer of the liver and the third leading cause of cancer-related death [7]. Clinical manifestations of HCC include constitutional symptoms of malignancy such as malaise, bodyweight loss, and abdominal discomfort due to large tumor mass, as well as symptoms of chronic liver disease or cirrhosis [8]. Patients with HCC may occasionally develop paraneoplastic syndromes characterized by hypoglycemia, hypercalcemia, or erythrocytosis. Besides the reasons same with other tumors mentioned above, HCC-induced hypoglycemia may also be due to more glycogen synthesis in the tumor but less glycogenolysis due to the decrease of normal liver tissue [9]. Although being recognized, hypoglycemia is uncommon as an early sign of HCC [10]. A case of a patient with recurrent hypoglycemic coma as the initial and single symptom of HCC is reported here. Thereafter, literature about its presentation and pathogenesis is reviewed. Case Report