Abstract

Case 1 A 54 year-old-male patient was admitted due to right upper quadrant abdominal pain for 1 month. Nineteen years ago, he had been diagnosed as chronic hepatitis B. Physical examination revealed palpable hepatomegaly. Total bilirubin was 1.4 mg/dL, AST/ALT was 265/82 IU/L, and AFP was 110,846 ng/ml. Abdomen CT showed large multilobular low attenuating mass occupying entire right hepatic lobe and medial segment of left lobe with massive thrombosis in right portal vein. He has been diagnosed as hepatocellular carcinoma by fine needle aspiration cytology of the liver mass. During admission period, he frequently showed hypoglycemic episodes with typical symptoms and very low blood glucose level of 30 to 61 mg/dl. He should keep continuous venous administration of glucose solution. He received one session of transarterial chemoembolization(TACE) and transferred to other hospital. Case 2 A 41 year-old-male patient was admitted due to indigestion for 1 month. Physical findings revealed tender hepatomegaly and multiple spider angioma on the superior chest area. Total bilirubin was 1.4 mg/dl, AST/ALT was 38/22 IU/L, and AFP was 23,140 ng/ml. Computed tomography showed 13cm sized, hyperattenuating mass involving right hepatic lobe with several daughter nodules and multiple metastatic lung nodules. Fine needle aspiration cytology of the liver mass demonstrated carcinoma. Gastroduodenoscopy demonstrated esophageal varix grade Ⅰ, benign gastric ulcer(body, lesser curvature, 0.5cm diameter), and duodenal ulcer scar. During admission period, he experienced multiple episodes of hypoglycemia with mental change and his blood sugar level was decreased up to 27 mg/dl. His blood IGF level was 26.0 ng/ml, IGF-Ⅱ 124 ng/ml. He was appled with one session of systemic chemotherapy with adriamycin, cisplatin and tamoxipen. After chemotherapy. pneumonia developed and was treated with antibiotics. He discharged without further follow-up.

• Keywords: Hypoglycemia;Hepatocellular carcinoma;Hepatocellular carcinoma;Hypoglycemai;IGF