Endocrine Abstracts

B-pancreatic cells are programmed to react to plasma glucose level with insulin secretion. Insulin secretion is precisely regulated and in the physiological conditions fasting glucose levels are maintained in the range 3.5–5.5 mmol/l. In hyperinsulinemic hypoglycemia, a disorder of the regulation of insulin secretion, insulin secretion continues at low concentrations of plasma glucose. In adults hyperinsulinemic hypoglycemia is the cause of 0.5 to 5.0% of hypoglicaemias and are result of eather β-cell tumor (insulinoma), or β-cell hyperplasia. Rapid diagnosis and treatment is essential in the prevention of acute and chronic complications of hypoglycaemia, especially in central nervous system.

We are presenting the 71-year-old patient who had been previously diagnostic evaluated at the primary health care level due to frequent episodes of unconsciousness and weakness periodically in period of 3 years prior to admission. After established refractory hypoglycemia patient was sent to our department where endogenous hyperinsulinism after 72-hour test of hunger was found. After endoscopic ultrasound showed probable β-cells hyperplasia of the body and tail of the pancreas. I-131 ocreotid scintigraphy of somatostatin receptors was negative. Calcium artery stimulation of the pancreas with insulin sampling from vein lienalis showed a clear gradient of insulin and distal pancreatectomy was suggested which patient refused. inhibitor of potassium channels-diazoxide was introduced in the therapy which led to reduction in subjective symptoms and no registered hypoglycaemas.