Endocrine Abstracts

Background: Hypoglycaemia is rare in people without diabetes. Certain medications are known to cause hypoglycaemia in non-diabetic patients.

Case details: A 65-year-old man with background congestive cardiac failure, previous pulmonary TB (1997), bronchiectasis and pulmonary fibrosis (long-term oxygen therapy) was admitted for exacerbation of bronchiectasis. He completed a course of antibiotics and steroid treatment. While awaiting discharge, he had two episodes of spontaneous hypoglycaemia (lowest blood glucose being 2.2 mmol/l on venous sample). He was referred to the Endocrine team at this point. On further questioning, he admitted similar episodic ‘funny turns’ associated with sweating and feeling faint over the previous 18 months. These episodes occurred in the morning, up to three times per month with no precipitant or prodrome and resolved spontaneously after about an hour. Consumption of carbohydrates seemed to aid symptom resolution.

Investigations: Subsequent inpatient investigations including short synacthen test and coeliac screen were normal. He also underwent a prolonged fast which was abandoned by the patient after 48-h with no further recorded hypoglycaemia as an inpatient. Thus it was not possible to measure insulin or C-peptide level. He was discharged from hospital with a glucometer. In the outpatient clinic, he reported further episodes which corroborated with low self-monitored glucose readings. A thorough medication review confirmed that his symptoms were contemporaneous with the commencement of the anti-hypertensive drug Ramipril. This prompted substitution of his Ramipril to Losartan. Since then he has returned to two clinic reviews over 5 months period and has not reported any further hypoglycaemic episode. He has not required a repeat 72-h fast.

Conclusion: We report a case of drug induced hypoglycaemia in a non-diabetic patient caused by Ramipril. There are few such reported cases in the literature. Our case illustrates the importance of considering rare drug side-effects with unusual presentations.