NUMEROUS SYNDROMES reflecting altered metabolism have been described in association with primary neoplastic disease.1The following case tells of a patient in whom primary carcinoma of the liver was associated with polycythemia, hypercalcemia, and profound hypoglycemia. Although the polycythemia and hypercalcemia were laboratory curiosities, the hypoglycemia resulted in recurrent syncope and ultimately determined the patient's clinical picture and the attendant problems of management. Spontaneous hypoglycemia and polycythemia have been reported separately in patients with hepatomas.2-7The association of the three has been recorded once by Schonfeld et al.8The additional findings of hypercalcemia in the current case of hepatoma is a previously unreported association. Report of a Case A 36-year-old Negro male died after a 7-month illness characterized by anorexia, fatigue, and weight loss in association with increasing hepatomegaly. There were no historical data to suggest nutritional, toxic, or infectious liver disease. Three months prior to death,