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Case Report
Severe hypoglycemia complicating hepatocellular carcinoma
1 Department of Endocrinology, Diabetology and Nutrition, Military Hospital Moulay Ismail, Meknes, Morocco
2 Faculty of Medicine and Pharmacy, University Sidi Mohamed Ben Abdellah, Fez, Morocco
3 Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
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Sara Derrou
Department of Endocrinology, Diabetology and Nutrition, Military Hospital Moulay Ismail, Meknes,
Morocco
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Article ID: 101119Z01SD2020
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Derrou S, Benabdelfedil Y, El Guendouz F, Ouleghzal H, Safi S. Severe hypoglycemia complicating hepatocellular carcinoma. Int J Case Rep Images 2020;11:101119Z01SD2020.ABSTRACT
Introduction: Paraneoplastic or ectopic endocrine syndromes are the consequence of aberrant hormonal production or of substances with hormonal effect, by a neoplastic tissue originally devoid of this endocrine activity. In this sense, hypoglycemia by extra-pancreatic tumors “non-islet cell tumor hypoglycemia” especially of hepatic origin is often severe and iterative.
Case Report: We report the clinical case of a 56-year-old patient, type 2 diabetic for 10 years, diagnosed with hepatocellular carcinoma with the onset of severe hypoglycemia attacks, persistent even after stopping treatment. The first-line assessment in search of renal failure, adrenal insufficiency, and hypothyroidism returned without abnormality. However, glycemic monitoring showed venous hypoglycemia at 0.38 g/L with concomitant insulinemia and low peptide C. Considering the clinical context, the insulin-like growth factor-1 (IGF1) was low. IGF2 was within normal limits. Given the inextricable and incurable nature of the tumor, dietary measures were required in our patient for stabilization of the blood sugar.
Conclusion: Hypoglycemia induced by tumor secretion of IGF2 is a rare paraneoplastic syndrome. It should be considered with tumor syndrome and organic hypoglycemia. Management remains poorly defined.
Keywords: Hepatocellular carcinoma, Insulin-like growth factor-2, Paraneoplastic syndrome, Severe hypoglycemia
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Author Contributions
Sara Derrou - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Yousra Benabdelfedil - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Fayçal El Guendouz - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Hassane Ouleghzal - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Somaya Safi - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2020 Sara Derrou et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
