S5537 Clinical Representation of the Warburg Effect in Stage IV Hepatocellular Carcinoma

Introduction: The Warburg effect is a metabolic phenomenon observed in cancer cells. It is characterized by aerobic glycolysis instead of mitochondrial oxidative phosphorylation as the primary mechanism of cellular energy generation. The exact benefit of such a metabolic switch is poorly understood, as aerobic glycolysis is thermodynamically more inefficient than mitochondrial oxidative phosphorylation. Case Description/Methods: Here, we present a case of a 40-year-old man with advanced stage 4 hepatocellular carcinoma with chronically low glucose levels measured in the 20s to 40s and completely asymptomatic. Upon examination, findings of sympathetic hyperactivity in the setting of hypoglycemia were absent, and the mentation was completely intact. This occurred in the absence of any states or medications known to induce hypoglycemia; concurrently, the patient demonstrated hyperphagia, suggesting increased metabolic demand in the setting of an immense, overwhelming tumor burden. During these hypoglycemic intervals, the patient's coagulation profile, including PT and international normalized ratio, remained within normal limits, suggesting sufficient residual hepatic parenchyma and glucogenic capacity. The patient's glucose remained extremely low, refractory to correction with multiple dextrose, D5, and D10 administrations. This suggests chronic systemic habituation to malignant cell consumption of serum glucose leading to adaptations to this hypoglycemia in highly metabolically active organs, such as the brain, heart, liver, and kidneys. Discussion: This report highlights the clinical utility of recognizing this metabolic state in the setting of advanced-stage malignancy with significant tumor burden and how it affects hospital glucose management. Its early recognition will lead to an increased ability to meet the patient's metabolic demands by administering appropriate, supplemental nutrition to satiate their hunger, potentially augmenting the delivery of palliative measures. This metabolic state may function as a surrogate marker, in conjunction with serum markers and imaging studies, for clinical determination of treatment escalation.