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“Riding High on Low Fuel” - Our Experience with Endogenous Hyperinsulinemic Hypoglycemia
INTRODUCTION: Endogenous hyperinsulinemic hypoglycemia (EHH) is a condition in which the insulin levels are inappropriately high in the presence of low plasma glucose. MATERIALS AND METHODS: We did a retrospective analysis of case records of those patients admitted and evaluated for EHH from June 20...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Medknow Publications & Media Pvt Ltd
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5628531/ https://www.ncbi.nlm.nih.gov/pubmed/28989869 http://dx.doi.org/10.4103/ijem.IJEM_174_17 |
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author | Manjunath, P. R. George, Belinda Mathew, Vivek Bantwal, Ganapathi Ayyar, Vageesh |
author_facet | Manjunath, P. R. George, Belinda Mathew, Vivek Bantwal, Ganapathi Ayyar, Vageesh |
author_sort | Manjunath, P. R. |
collection | PubMed |
description | INTRODUCTION: Endogenous hyperinsulinemic hypoglycemia (EHH) is a condition in which the insulin levels are inappropriately high in the presence of low plasma glucose. MATERIALS AND METHODS: We did a retrospective analysis of case records of those patients admitted and evaluated for EHH from June 2004 to June 2016 in our center, excluding those that were diagnosed with reactive hypoglycemia. We collected data regarding demographics, clinical presentation, laboratory results, localization techniques, and treatment administered. RESULTS: Sixteen patients who were admitted for evaluation based on history suggestive of repeated hypoglycemic episodes were included in the study. All but one pregnant patient was subjected to a supervised fast in the hospital. All patients developed hypoglycemia (defined using Whipple's triad) within the first 24 h. Three patients had autoimmune hypoglycemia which differed significantly from insulinoma-mediated hypoglycemia in certain clinical and laboratory parameters. They were older in age with marked fluctuations in the 24 h glucose profile ranging from frank hypoglycemia to frank hyperglycemia. The insulin levels were markedly elevated in this group of patients along with a significantly elevated insulin C peptide molar ratio (ICMR) when compared with patients with insulinoma-mediated hypoglycemia. CONCLUSIONS: Although insulinoma is the most common cause of EHH, autoimmune hypoglycemia should be considered as a differential diagnosis, particularly in older individuals with plasma glucose values increasing to the hyperglycemic range. Degree of elevation of insulin levels and ICMR may provide additional clues. Overall, the survival and prognosis of patients with EHH are excellent. |
format | Online Article Text |
id | pubmed-5628531 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Medknow Publications & Media Pvt Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-56285312017-10-06 “Riding High on Low Fuel” - Our Experience with Endogenous Hyperinsulinemic Hypoglycemia Manjunath, P. R. George, Belinda Mathew, Vivek Bantwal, Ganapathi Ayyar, Vageesh Indian J Endocrinol Metab Original Article INTRODUCTION: Endogenous hyperinsulinemic hypoglycemia (EHH) is a condition in which the insulin levels are inappropriately high in the presence of low plasma glucose. MATERIALS AND METHODS: We did a retrospective analysis of case records of those patients admitted and evaluated for EHH from June 2004 to June 2016 in our center, excluding those that were diagnosed with reactive hypoglycemia. We collected data regarding demographics, clinical presentation, laboratory results, localization techniques, and treatment administered. RESULTS: Sixteen patients who were admitted for evaluation based on history suggestive of repeated hypoglycemic episodes were included in the study. All but one pregnant patient was subjected to a supervised fast in the hospital. All patients developed hypoglycemia (defined using Whipple's triad) within the first 24 h. Three patients had autoimmune hypoglycemia which differed significantly from insulinoma-mediated hypoglycemia in certain clinical and laboratory parameters. They were older in age with marked fluctuations in the 24 h glucose profile ranging from frank hypoglycemia to frank hyperglycemia. The insulin levels were markedly elevated in this group of patients along with a significantly elevated insulin C peptide molar ratio (ICMR) when compared with patients with insulinoma-mediated hypoglycemia. CONCLUSIONS: Although insulinoma is the most common cause of EHH, autoimmune hypoglycemia should be considered as a differential diagnosis, particularly in older individuals with plasma glucose values increasing to the hyperglycemic range. Degree of elevation of insulin levels and ICMR may provide additional clues. Overall, the survival and prognosis of patients with EHH are excellent. Medknow Publications & Media Pvt Ltd 2017 /pmc/articles/PMC5628531/ /pubmed/28989869 http://dx.doi.org/10.4103/ijem.IJEM_174_17 Text en Copyright: © 2017 Indian Journal of Endocrinology and Metabolism http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Manjunath, P. R. George, Belinda Mathew, Vivek Bantwal, Ganapathi Ayyar, Vageesh “Riding High on Low Fuel” - Our Experience with Endogenous Hyperinsulinemic Hypoglycemia |
title | “Riding High on Low Fuel” - Our Experience with Endogenous Hyperinsulinemic Hypoglycemia |
title_full | “Riding High on Low Fuel” - Our Experience with Endogenous Hyperinsulinemic Hypoglycemia |
title_fullStr | “Riding High on Low Fuel” - Our Experience with Endogenous Hyperinsulinemic Hypoglycemia |
title_full_unstemmed | “Riding High on Low Fuel” - Our Experience with Endogenous Hyperinsulinemic Hypoglycemia |
title_short | “Riding High on Low Fuel” - Our Experience with Endogenous Hyperinsulinemic Hypoglycemia |
title_sort | “riding high on low fuel” - our experience with endogenous hyperinsulinemic hypoglycemia |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5628531/ https://www.ncbi.nlm.nih.gov/pubmed/28989869 http://dx.doi.org/10.4103/ijem.IJEM_174_17 |
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