Background: There are many causes of the etiology of hypoglycemia. Hypoglycemia is very rare in individuals without diabetes. Although it can accompany islet cell malignancies such as insulinoma, it is much less common in solid organ tumors such as hepatocellular carcinoma as a component of paraneoplastic syndrome. Case Presentation: We present a 58-year-old male patient with no additional disease, who was examined for resistant hypoglycemia and was diagnosed as having hepatocellular carcinoma radiologically for the first time. Insulin level measured when serum glucose was 44 mg/dl: 0.4 μU/mL, c-peptide level: 0.355 ng/mL detected. Viral serology was found to be positive for HbsAg. In dynamic magnetic resonance imaging, showing continuity in segments 6 - 7 and 8 in the right lobe, and also partially towards 5, heterogeneous hyperintense in T2 A’s, diffusion-limiting, heterogeneous contrast enhancement in postcontrast series, cystic-necrotic in the center. The alpha-fetoprotein level was 60,500 ng/mL. Conclusion: Paraneoplastic hypoglycemia due to underlying malignancies should be considered in patients presenting with hypoglycemia.
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