Jiaming is 39 years old and has just returned home from an MBA program abroad to work as a general manager in a large company in China. He is busy with all kinds of socializing and socializing all day long, and he is very happy in his work. Normally, he is very healthy and has no hepatitis, but he often drinks because of the socializing at work. Every year, he has a health checkup, and no problems were found. However, in the recent period, he often feel energy is not concentrated, thinking and language is also a little slow, the mind all day drowsiness, sometimes even in public places random urination and defecation, urination and defecation after their own do not know; sometimes also take out the money to spread around, often do not sleep at night, fear, alarmed that the house is full of ghosts, rats, cats and so on. Yelling “don’t drive the rats to the house”, and called the family to fight the ghosts, but also said that the house is full of red silk and green silk, the whole day restlessness. Such strange behavior, at first, is still accidental, after a period of time, the attack is more frequent, every week there will be so once or twice. But after a while, it was quite lucid again. Almost every time after an attack, he would sweat a lot. People said behind his back that he was “mentally ill” due to the stress of his work. So, his family forced him to take him to the hospital for a checkup. After a thorough examination, the doctor found that Jiaming was suffering from primary liver cancer, not “mental illness”. Primary liver cancer is a highly malignant disease, which is frightening and intimidating. If diagnosed and treated early, the prognosis can be improved. Liver cancer patients often show symptoms such as vague pain in liver area, weakness, gradual weight loss or low fever, loss of appetite, abdominal fullness and so on. In addition to the above symptoms, some primary liver cancer tumors cause special systemic symptoms outside the liver. Recognizing these symptoms is of great significance for early detection of liver cancer. Extra-hepatic manifestations of liver cancer include abnormal changes in endocrine, neuromuscular, connective tissue, blood system and blood vessels, also known as accompanying cancer syndrome. Jiaming’s hypoglycemia is a kind of extra-hepatic manifestation of liver cancer, which is also known as “fuzzy hypoglycemia” complicated by primary liver cancer in medicine. At the time of the attack, Jiaming’s blood glucose was only one-tenth of the normal blood glucose. During the episode of fuzzy hypoglycemia, brain dysfunction is caused by insufficient supply of glucose to the brain cells along with reduced supply of oxygen. There can be various manifestations, such as inattentiveness, slowness of thought and speech, dizziness, drowsiness, blurred vision, unsteadiness, hallucinations, agitation, irritability, childish movements, strange behavior, muscle tremors, movement disorders, and even convulsions, coma, etc. The patient will wake up on his own after a period of time. It lasts for some time and the patient will wake up on his own. Sometimes, the patient will recover immediately when given glucose, but it is often easily misdiagnosed. According to the research of Prof. Dickinson of Manchester Royal Hospital in Britain, about 19.1% to 36.4% of primary liver cancer patients are complicated with hypoglycemia. Why does primary liver cancer have this symptom? It is generally believed that sugar storage in the liver is reduced due to the fact that most of the normal liver is occupied by liver cancer. In addition, some scholars believe that it is due to the ectopic secretion of insulin or secretion of a kind of insulin β-cell stimulating factor by hepatocellular carcinoma cells, which causes hypoglycemia; however, some scholars believe that it is due to the fact that hepatocellular carcinoma tissues can utilize glucose but cannot make glucose, so it causes hypoglycemic reaction. When hypoglycemia occurs in patients, due to the sympathetic nerves and adrenal medulla reacting to hypoglycemia and releasing a large amount of adrenaline-induced symptoms, such as generalized weakness, excessive sweating, panic, trembling of hands, pale skin, hunger, etc.; due to the cerebral dysfunction caused by insufficient supply of glucose to brain cells accompanied by reduced supply of oxygen, which then causes a series of neurological and psychiatric symptoms. Common extrahepatic symptoms of hepatocellular carcinoma, besides hypoglycemia mentioned above, the following symptoms can also occur: 1. Erythrocytosis. It is usually considered that the presence of erythrocytosis in patients with cirrhosis is a clue to the diagnosis of early liver cancer and should be highly valued. This is caused by hepatocellular carcinoma cells producing excessive erythropoietin or the predecessor of erythropoiesis-stimulating factor. 2.Hyperlipidemia. Hyperlipidemia is one of the systemic symptoms of liver cancer. It is caused by liver cancer cells producing too much β-lipoprotein. 3.Hypercalcemia or hypocalcemia. Recently, it is considered by many scholars as a serious complication of certain liver cancer patients. Primary liver cancer tissues can synthesize parathyroid hormone, and the increased concentration of parathyroid hormone in the blood causes hypercalcemia; while hypocalcemia is the result of patients’ poor absorption of fat, which is related to patients’ hypoproteinemia. 4. Liver cancer also causes porphyrin metabolism disorder and skin porphyria. When the above symptoms appear, especially for those who have hepatitis and cirrhosis, long-term alcoholism and intestinal parasitic disease history, they should not only stay on the surface of the symptoms, but should be suspected whether they have primary hepatocellular carcinoma or hepatocellular carcinoma. Close observation should be made and further examination should be conducted in a timely manner so that the condition will not be jeopardized.