CLINICAL STUDIES ON HYPOGLYCEMIA IN HEPATOCELLULAR CARCINOMA

Abstract

A hypoglycemia is one of the manifestations of paraneoplastic syndrome seen in hepatocellular carcinoma (HCC). Studies were made on seventeen cases of HCC with hypoglycemia, concerning the pathogenetic mechanism of the hypoglycemia associated with HCC.
A hypoglycemia was observed in 2.9% of all HCC cases. It occured usually as a terminal sign of the patients with HCC. HCC with hypoglycemia generally showd to have a rapid growing giant tumor, rapid elevation of AFP and frequent association of other signs of paraneoplastic syndrome.
Most of these cases were associated with liver cirrhosis and had a slow decrease of fasting blood glucose in he clinical course, and were demanded a large amount of glucose administration to be corrected.
They showed no characteristic liver pathology for hypoglycemia and so did pancreatic histology.
The glucose tolerance test revealed a flat curve, low responce of IRI and c-peptide, and high level of fasting glucagon. Therefore insulin, insulin-like avtivity and glucagon were considered to have less primarily contribution to the pathogenesis of hypoglycemia.
It was consequently concluded that a hypoglycemia with HCC was mainly caused by excess glucose conssumption because of rapid growing giant tumor, and by decrease of glucose production in the liver plus malnutrition because of regression of liver parenchyma of glucose metabolism in the liver due to encoachment of the tumor and the presence of the liver cirrhosis.