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Published on: July 31, 2016
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Persistent hypoglycemia in patients with liver cancer
Kemal Fariz Kalista1, Hanum Citra Nur Rahma2, Dicky Levenus Tahapary3
1Division of Hepatobiliary, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
Endocrinology, Diabetes & Metabolism Case Reports
|July 2, 2024
Summary
Hypoglycemia in liver cancer patients often indicates a poor prognosis, frequently occurring in advanced stages. Supportive treatments like dextrose infusions and steroids can help manage blood glucose levels when tumor cytoreduction is not feasible.
Area of Science:
- Oncology
- Endocrinology
- Hepatology
Background:
- Hypoglycemia is a critical paraneoplastic syndrome manifestation in primary and secondary liver cancer, signaling a poor prognosis.
- It typically presents in advanced stages, complicating treatment due to extensive tumor burden.
- The underlying mechanisms involve liver parenchyma replacement by tumor and excessive insulin growth factor (IGF) production.
Purpose of the Study:
- To characterize patients with primary and secondary liver cancer presenting with hypoglycemia.
- To analyze the clinical profile, management, and outcomes of these patients.
- To identify effective supportive treatments for hypoglycemia in advanced liver cancer.
Main Methods:
- A case series of 41 liver cancer patients with hypoglycemia admitted to a tertiary referral hospital in Indonesia.
- Data collection included patient demographics, clinical presentation, tumor characteristics, blood glucose levels, Child-Pugh scores, and treatment modalities.
- Analysis of treatment responses and mortality rates.
Main Results:
- Hepatocellular carcinoma was the most frequent diagnosis (51.2%), followed by metastatic liver disease (14.6%).
- Patients were predominantly male (65.9%) with a mean age of 47.7 years, often presenting with jaundice (58.5%) and hepatomegaly (70.7%).
- Mean initial blood glucose was 42.15 mg/dL, with a high Child-Pugh score (9.93). Tumor characteristics included large size (mean 12.6 cm), multiplicity, and bilateral lobe involvement in most cases. Supportive treatments achieved blood glucose control in 41.5% of patients, while 56.1% were refractory. Mortality was high at 70.7%, occurring shortly after hypoglycemia onset.
Conclusions:
- Hypoglycemia in advanced liver cancer is challenging to manage, often precluding curative tumor treatment like cytoreduction.
- Supportive therapies including frequent meals, intravenous dextrose, and steroids are crucial for glycemic control.
- Steroids demonstrate efficacy by stimulating gluconeogenesis and modulating the GH-IGF axis, offering a vital role in managing persistent hypoglycemia.
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