A Case of Hepatocellular Carcinoma With Initial Presentation of Non-Islet Cell Tumor Hypoglycemia

NICTH (Non-Islet Cell Tumor Hypoglycemia) is hypoglycemia caused by extrapancreatic tumors. A 29 year old man presented with decreased consciousness, often felt weak, trembling and sometimes had stomach pains at home. In the last month the patient has experienced hunger and thirst easily. Blood glucose at arrival was 5 mg mg/dl, C Peptide level 0.04 ng/ml, Triglycerides 221 mg/dl and Ct results Abdomen Multifocal hepatoma in the left lobe. Despite repeated episodes of hypoglycemia during the eight days of treatment, blood glucose levels began to stabilize after receiving glucocorticoids. Because tumor-induced hypoglycemia is uncommon, the diagnosis of NICTH is frequently missed. To confirm the diagnosis of NICTH, additional tests such as IGF II, IGF I, insulin, proinsulin, and beta hydroxybutyrate are needed. Increased production of Insulin Growth Factor II (IGF-II) by tumor cells can be used to diagnose hypoglycemia caused by non-islet cell tumors.NICTH (Non-Islet Cell Tumor Hypoglycemia) is hypoglycemia caused by extrapancreatic tumors. A 29 year old man presented with decreased consciousness, often felt weak, trembling and sometimes had stomach pains at home. In the last month the patient has experienced hunger and thirst easily. Blood glucose at arrival was 5 mg mg/dl, C Peptide level 0.04 ng/ml, Triglycerides 221 mg/dl and Ct results Abdomen Multifocal hepatoma in the left lobe. Despite repeated episodes of hypoglycemia during the eight days of treatment, blood glucose levels began to stabilize after receiving glucocorticoids. Because tumor-induced hypoglycemia is uncommon, the diagnosis of NICTH is frequently missed. To confirm the diagnosis of NICTH, additional tests such as IGF II, IGF I, insulin, proinsulin, and beta hydroxybutyrate are needed. Increased production of Insulin Growth Factor II (IGF-II) by tumor cells can be used to diagnose hypoglycemia caused by non-islet cell tumors.