Paraneoplastic Hypoglycemia in Hepatocarcinoma: Case Report and Literature Review

Hypoglycemia is a common medical emergency in the context of insulin treatment in diabetic patients and oral hypoglycemic agents such as sulfonylureas. In anecdotal cases, hypoglycemia is associated with non-islet cell tumor-induced hypoglycemia (NICTH). In hepatocellular carcinoma (HCC), it has been reported in 4-27% of patients, and it is associated with poor prognosis. We present a case report of a patient with hypoglycemia associated with HCC secondary to chronic hepatitis B virus infection without response to treatment with glucagon, steroids, octreotide, and embolizations, who required parenteral nutrition at home. Even though hypoglycemia associated with HCC is a recognized entity, there is not sufficient evidence in its treatment and prevention. The article aims to review the literature on prevention and therapeutic options.