Endocrine Abstracts

Introduction

As hypoglycemia is a common symptom, an organic cause is always the first diagnosis looked for as it can be associated with a specific medical or surgical treatment. Diagnosis of functional etiology isn’t as precise, as the whipple triad can be incomplete. We herein report a serie of confirmed etiology for functional hypoglycemia.

Methods

This is a descriptive retrospective study including 20 cases of functional hypoglycemia. The etiology was assessed either by using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) or by performing an oral glucose tolerance test (OGTT).

Results

Four patients had gastric emptying disorders, three men and one woman. Mean age was 49 years, 3 patients had a history of pyloroplasty and vagotomy, and one patient had partial gastrectomy. Neurogenic signs were noted in all patients, and 3 patients had neuroglycopenic symptoms such as headaches in 3 patients and loss of conscience in one. In 3 cases, body mass index (BMI) was normal, one patient was overweight. None of the patients changed weight. All patients had an early postprandial hypoglycemia, with hypoglycemia at 60 min in 2 cases and at 120 min in 2 cases at OGTT, with a mean glycemia of 0.52 ± 0.07 g/l. They were put under dietary measures with approvement of symptoms. Ten patients had a risk state of diabetes mellitus, 7 men and 9 women. Mean age was 37 ± 12 years. Twelve had family history of type 2 diabetes. Three patients had a normal BMI, 7 were overweight and 6 were obese. All patients had neurogenic symptoms and 12 had neuroglycopenic signs. Hypoglycemia was late post prandial in 13 cases and without clear timing in 3 cases. Mean glycated hemoglobin was 5.62 ± 0.48% in the 10 cases it was assessed. Kidney, liver and thyroid parameters were normal. Hyperinsulinism and insulin resistance was confirmed with a HOMA-IR at 6.35 ± 3.65 in 11 cases, and in the 5 cases with no confirmed insulin resistance, there was an inadequate insulin response to OGTT with a mean hypoglycemia at 210 min, mean glycemia at 0.6 ± 0.06 g/l and insulin 5 times more than basal insulin. Prediabetes was confirmed in 7 cases. All patients had dietary measures with improvement of hypoglycemia.

Conclusion

Functional hypoglycemia remains an important diagnosis to think of in the situation of spontaneous hypoglycemia, as investigations differ from organic etiologies and first line treatment is dietary intervention that can improve and treat efficiently the symptoms.