The incidence and characteristics of some paraneoplastic syndromes of hepatocellular carcinoma in Nigerian patients

Objective To determine whether paraneoplastic syndromes of hepatocellular c arcinoma such as erythrocytosis, hypoglycaemia, hypercholesterolaemia and h ypercalcaemia are found in Nigerian patients with this tumour, and, if pres ent, to determine their incidence and characteristics. Design Consecutive patients with a diagnosis of hepatocellular carcinoma se en over a 10-year period at Ile-Ife, Nigeria, underwent haematocrit (100 pa tients), plasma glucose (65), cholesterol (65) and calcium studies (30). Sh ortage of laboratory reagents did not allow all the 100 patients to be test ed for plasma glucose, cholesterol and calcium. Methods Haematocrit was determined by the microhaematocrit method, and the glucose oxidase-peroxidase, Liebermann-Burchard and O-cresolphthalein compl exone methods were employed for the estimation of plasma glucose, cholester ol and calcium respectively. Results The haematocrit values ranged from 19 to 63% with a mean of 34.51% (SD 7.72). Only 1 out of 100 patients (1%) had erythrocytosis (haematocrit 63%). Sixty-five patients had their plasma glucose determined. The range of values for fasting plasma glucose (FPG) was 1-8.4 mmol/l with a mean of 4. 3 (SD 1.6). Hypoglycaemia occurred in 18 patients (27.7%) (14 males, 4 fema les). The mean liver span for patients with FPG > 5.0 mmol/l was 16.87 cm ( SD 3.03), while the value for those with FPG < 3.0 mmol/l was 22.0 cm (SD 6 .14, P< 0.05). Plasma cholesterol was determined in 65 patients and the ran ge of values was 2.1-18.1 mmol/l with a mean of 5.65 (SD 2.42). Hypercholes terolaemia occurred in 16 patients (24.6%) (15 males, 1 female). The range of plasma calcium obtained in 30 patients was 1.6-3.15 mmol/l with a mean o f 2.36 (SD 0.32). Three patients (10%) tall males) had hypercalcaemia. Conclusion While erythrocytosis has a low incidence, hypoglycaemia and hype rcholesterolaemia are important paraneoplastic syndromes of hepatocellular carcinoma in Nigerian patients. The study confirms that the larger the live r mass, the greater the tendency towards hypoglycaemia. Also, the paraneopl astic syndromes studied occurred predominantly in hepatocellular carcinomas with cirrhosis. fur I Gastroenterol Hepatol 11:1401-1404 (C) 1999 Lippinco tt Williams & Wilkins.