Increased insulin-like activity of the serum and tumor tissue in a patient with hypoglycemia associated with hepatocellular carcinoma

We have already reported on an autopsy case of hepatocellular carcinoma in which there were frequent attack of hypoglycemia and in which we detected ILA (insulin-like activity) in both blood and tumor tissue. The patient was a 74 year old male who was referred to our department after he became unconscious. At the time of admission, laboratory investigation revealed severe hypoglycemia (24mg/d/) and elevation of the serum AFP. Both the liver CT scan and an ultrasound scan strongly suggested primary hepatocellular carcinoma. On the 30th day of hospitalization the patient died of renal failure. During the autopsy, the liver weighted 1770 g and cirrhosis was present. A tumor had extended into the IVC and the right atrium. Histologically, the liver tumor was identified as hepatocellular carcinoma (Edmondson Grade II-III). No islet cell hyperplasia of pancreas was observed. A blood sample showed 6200μU of ILA per milliliter, 30 times greater than the normal value. A tissue extract showed 20-25mU per gram of neoplasm and 0.05-0.2mU per gram of non-neoplasm in the rat epididymal fat pad assay. Hypoglycemia, as associated with hepatocellular carcinoma, has a well-known relation to paraneoplastic syndrome, although the hypoglycemia mechanism has not been definitely determined yet. In this case we conclude that the role of ILA was very important.