Endocrine Abstracts

Introduction: Hypoglycemia is common in diabetic patients as an adverse effect of their medication. A minority of hypoglycemia occurs in non-diabetic patients. This spontaneous hypoglycemia defined by the Whipple’s triad results from organic (non-reactive) or functional (reactive) causes, and in few cases, a factitious hypoglycemia, posing an etiological problem. The aim of our study was to assess clinical and biological features of non-reactive hypoglycemia in non-diabetic adults.

Methods: This is a descriptive, retrospective and single-center study including 65 patients with a confirmed hypoglycemia according to the presence of Whipple’s triad. Patients without a precise cause of hypoglycemia, patients with factitious hypoglycemia and those with iatrogenic causes were excluded. Clinical and paraclinical features were collected and compared between patients with non-reactive hypoglycemia (group 1) and those with reactive hypoglycemia (group 2).

Results: The study population included 40 patients with a sex-ratio of 1.6 and a mean age of 45.3 ± 16.6 years. The diagnosis of non-reactive hypoglycemia (adrenal insufficiency n = 22, insulinoma n = 4) was established in 26 cases (65%) and reactive hypoglycemia in 14 cases (35%). There was no significant difference between the two groups according to the age (group1: 45.9 ± 18.3 years, group2: 44.1 ± 13.4 years, P = 0.8). A female predominance was found in group 1 (73% vs 43% in group 2, OR = 3.6, P = 0.06). Fasting hypoglycemia was more frequent in group 1 (66%) than in group 2 (7%) (OR = 20.8, P = 0.001). The prevalence of neuroglycopenic symptoms was 81% in group 1 vs 64% in group 2 (P = 0.22). Group 1 had a lower body weight (65.1 ± 16.2 kg vs 75.2 ± 12.0 kg in group2, P = 0.03) a lower systolic blood pressure (11.1 ± 1.7 cmHg vs 12.2 ± 1.6 cmHg, P = 0.05) and diastolic blood pressure (6.9 ± 0.9 vs 7.7 ± 0.9, P = 0.03). The prevalence of overweight was 48% in group 1 vs 52%, in group 2 (P = 0.06). A blood glucose level < 0.3 was found in 23% in group 1 vs 0% in group 2, (P = 0.06)

Conclusion: Non-reactive hypoglycemia was predominant comparing to reactive causes, with a female predominance, related to the higher prevalence of adrenal insufficiency in women. The predictive factors of organicity were fasting hypoglycemia, blood glucose level < 0.3, lower body weight and lower blood pressure. Fasting hypoglycemia is the most predictive and should guide etiologic investigations toward organic causes.