Pro-IGF2-induced hypoglycaemia associated with hepatocellular carcinoma

Area of Science:

• Endocrinology
• Oncology
• Metabolic Disorders

Background:

• Hepatocellular carcinoma (HCC) is a primary liver cancer.
• Tumor-induced hypoglycemia is a rare paraneoplastic syndrome.
• Non-islet cell tumor hypoglycemia (NICTH) can be associated with various malignancies.

Purpose of the Study:

• To report a case of NICTH in a patient with advanced hepatocellular carcinoma.
• To highlight the diagnostic criteria and management of NICTH.
• To emphasize the importance of comprehensive hormonal assessment for diagnosing NICTH.

Main Methods:

• Case report of an 87-year-old female patient with HCC presenting with loss of consciousness.
• Biochemical evaluation including glucose, insulin, c-peptide, cortisol, IGF1, IGF2, and Pro-IGF2 levels.
• Treatment with intravenous glucose, followed by prednisolone.

Main Results:

• The patient presented with severe hypoglycemia, diagnosed as NICTH.
• Hormonal profile showed low insulin, c-peptide, and IGF1, with a high IGF2:IGF1 ratio.
• Prednisolone treatment effectively managed hypoglycemia, avoiding glucose infusions.

Conclusions:

• Hepatocellular carcinoma can be associated with non-islet cell tumor hypoglycemia (NICTH).
• NICTH is characterized by low insulin and IGF1 levels.
• Accurate diagnosis of NICTH necessitates measurement of IGF2, Pro-IGF2, and IGF1.