Extremely Severe Hypoglycemia in a Patient Who Experienced Spontaneous Rupture of a Hepatocellular Carcinoma

An 85-year-old woman was brought to the emergency room because of shock and coma. She was found to have extreme hypoglycemia (blood glucose <10 mg/dL), associated with the spontaneous rupture of an endstage Hepatocellular Carcinoma (HCC). Because the patient had declined any treatment for her HCC during the preceding year, no specific treatment was instituted for the ruptured HCC. Intravenous infusion of high-glucose fluid normalized her blood glucose concentration within 4 hours, but she died further 6 hours later. At autopsy, neither insulinoma nor a malignancy other than the HCC was identified. Her liver weighed 1,290 g and was filled with tumor masses. The HCC cells were negative for insulin-like growth factor 2 expression on immunohistochemistry, indicating that the extreme hypoglycemia was not a “Non-Islet Cell Tumor Hypoglycemia (NICHT)”.