PakMediNet Discussion Forum : Medicine : Recurrent Hypoglycemia?
Recurrent Hypoglycemia?
We have admitted a patient 60 years old man, presents with recurrent attacks of hypoglycemia documented upto 26mg/dl, from last 1 month. He has unawareness of hypoglycemia above 30mg/dl and his repeated measurements are around 35, 38 and 40 mg/dl. His examination is normal and has normal blood pressure. There is no history of low blood pressure.
We investigated the patient and advised C-Peptide levels, Insulin levels, and Early morning Cortisol followed by ACTH stimulation test.
The results are:
C-Peptide : 7.6 (high)
Insulin: 880 (very high)
ACTH Stimulation Test: abnormal
We started him on Prednisolone in a dose of 15mg/day (stress dose) and advised MRI of pancreas / adrenals.
MRI report came to be normal. No mass or any lesion in pancreas / adrenals is detected.
Repeat Insulin levels came around 380.
How to proceed now? Are there any other tests to investigate this condition ?
Posted by: docosama Posts: 333 :: 28-11-2006 :: | Reply to this Message
Re: Recurrent Hypoglycemia?
Dear Docosama,
Very rare case,Insulinoma ? Work up for MEN 1, make sure to have serum Ca and prolactin, if desired and available head MRI is a good idea just for the completion of work up and to rule out pitutary tumor. I will interested in knowing the exact result of ACTH test.
If possible preoperative localization of tumor is desireable by intraabdominal USG and scintigrapphy of pancrease or by selective angiography of the pancreatic arterial supply.Otherwise leave it to a surgeon and beleive in his expertise for peroperative localization with or without USG.
[Edited by iqbalmd on 01-12-2006 at 01:12 AM GMT]
Posted by: iqbalmd Posts: 22 :: 30-11-2006 :: | Reply to this Message
Re: Re: Recurrent Hypoglycemia?
plzzzzz do proceed with further arguments on this case.
i doubt wether there would be pituatary tumour.
what if we think of anxiety as an important factor for causing hypoglycemia
could it lead to increased consumption of carbs...could it cause increased secretion of insulin
?
Posted by: friendy Posts: 2 :: 19-02-2007 :: | Reply to this Message
Re: Recurrent Hypoglycemia?
anxiety doesnt cause hypoglycemia, rather it causes hyperglycemia due to release of stress hormones.
The above patient is adviced Pancreatic Angiography for the localization of Insulinoma, but he hasnt gone for it yet.
Posted by: docosama Posts: 333 :: 28-02-2007 :: | Reply to this Message
Re: Recurrent Hypoglycemia?
I would like to know the rationale of using corticosteroids in this patient?
Posted by: khurrshaz Posts: 2 :: 10-08-2007 :: | Reply to this Message
Re: Recurrent Hypoglycemia?
i would agrre with the workup for insulinoma and MEN.I also fail to understand the rationale for steroids.maybe a sulfonyurea level can be done to rule out an accidental ingesion.
Posted by: SARSH Posts: 2 :: 20-08-2007 :: | Reply to this Message
Re: Recurrent Hypoglycemia?
i wonder what the diagnosis ended up to be.
there is a possibility of islet cell hyperplasia or an extra pancreatic tumor secreting insulin like growth factor.do post the diagnosis and treatment given.
Posted by: drnasar Posts: 2 :: 24-04-2008 :: | Reply to this Message
Re: Recurrent Hypoglycemia?reason for starting steroids is associated "adrenal insufficiency" as evident by positive Short Synecthan test.
Posted by: docosama Posts: 333 :: 25-04-2008 :: | Reply to this Message