Two cases of hepatocellular carcinoma associated with hypoglycemia

Studies on pathophysiological mechanisms

Abstract

Two patients with hepatocellular carcinoma, associated with hypoglycemia, are described. First case is a 60-year-old male who had a history of posttransfusion hepatitis fifteen years ago, progressed into cirrhosis of the liver and eventually to hepatoma, and died of gastrointestinal bleeding one month after admission. Second case is a 61-year-old male with liver cirrhosis who progressed to hepatoma during the course of following his clinical course by periodical examinations for eleven years. Hypoglycemia developed at terminal stages of the disease on both cases. Parenteral glucose load revealed low responses of insulin and glucagon. Moderate increase in blood lactic acid was found during hypoglycemic episode (second case). A marked decrease of glucose-6-phosphatase activity with elevated hexokinase level in tumor tissue was found upon examination of the necropsy material on the second case. Autopsy examination of these cases disclosed that almost all of the livers were replaced by tumor masses and no islet cell hyperplasia of the pancreas was observed.
Data obtained indicate the possibility that the mechanism of hypoglycemia of these patients is due to the unbalance existing between glucose utilization and synthesis resulting from the enhanced glycolysis of substantially grown hepatoma tissues and from the lack of gluconeogenic capacity due to virtual loss of residual liver tissues.