SAT170 Paraneoplastic Hypoglycemia Secondary To Hepatocellular Carcinoma

Abstract

Abstract Disclosure: S. Dejhansathit: None. N. Sheung: None. A. Akofu: None. A. Uddin: None. F. marium: None. N.G. Akabogu: None. W. Salam, MD: None. Introduction: Hypoglycemia is a known but rare Paraneoplastic manifestation of hepatocellular carcinoma and can lead to significant morbidity and mortality. Even though HCC-related hypoglycemia is a known entity, knowledge about prevention and treatment is limited. Case Description: We report a 36-year-old male with no significant past medical history presenting initially to emergency room for abdominal pain and distension for 2 months. He reported associated 10 pounds unintentional weight loss, fatigue, night sweat and loss of appetite in the past 3 months. The patient noted to have hypoglycemia with blood glucose of 20 mg/dl on admission. He was given 2 ampoules of 50% dextrose and started on 5% dextrose solution intravenously. A CT abdomen and pelvis showed enlarged heterogenous liver with numerous hepatic lesions, concerning for multifocal hepatocellular carcinoma. A liver biopsy was done and confirmed hepatocellular carcinoma. Labs showed alpha fetoprotein level over 60500 ng/mL (0-8.3 ng/mL). Hepatitis B surface antigen was reactive with positive hepatitis B DNA, confirming the diagnosis of chronic hepatitis B infection. Gastroenterology, Oncology and Surgical Oncology were consulted. Patient was felt not to be a good surgical or transarterial chemo-embolization. Endocrinology was consulted when patient develops scrotal and legs swelling after receiving high rate of dextrose fluid since admission to maintain blood glucose. Prednisone 20 mg twice a day was initiated and later increased to 30 mg twice day after 2 days without significant improvement. Prednisone was then switched to dexamethasone 4 mg four times a day for longer half-life. 10% dextrose was slowly decreased from 200cc/hr to100cc/hr but resulted in rebound hypoglycemia. Somatropin 4 mg daily was also added with a goal to further decrease fluid rate in order to help with his discomfort from swelling. 10% dextrose was eventually decreased to 75 cc/hr. Patient subsequently opted for hospice care and passed away within 24 hours. Discussion: The paraneoplastic hypoglycemia associated with HCC can be classified into two categories. Type A hypoglycemia is usually found in the late-stage HCC when tumor burden is high. Type B hypoglycemia is caused by an increase in pro-IGF-2 level that is incompletely processed by the tumor cells, stimulating insulin receptors. It is likely our patient had type A hypoglycemia due to the extensive tumor burden. Overall, paraneoplastic hypoglycemia associated with HCC has very poor prognosis and high mortality rate. There is no single effective management and combination of steroids and Somatropin may provide palliative improvement as seen in our patient. Presentation: Saturday, June 17, 2023