Endocrine Abstracts

Keywords: Hypoglycemia- non-diabetic patients

Introduction

Hypoglycemia in non-diabetic patients is a rare entity, diagnosed by the presence of Whipple’s triad (plasma glucose concentration less than 50 mg/dl, neuroglycopenic-symptoms, and resolution of symptoms after the correction of hypoglycemia). It may be secondary to several etiologies, including tumors that may be malignant. Prolonged supervised fasting is frequently used to diagnose and orientate the etiological investigations. The aim of our study is to describe the initial symptoms, the evaluation and management of hypoglycemia in patients without diabetes mellitus.

Patients-methods

This is a retrospective and descriptive study including non-diabetic patients admitted in the Endocrinology-Diabetology and Nutrition Department of the Mohammed-VI University-Hospital-Center of Oujda-Morrocco, for the exploration and management of hypoglycemia. All patients have benefited from a clinical examination, biological and radiological exploration.

Results

We have collected 07patients admitted to our department for hypoglycemia. No history of diabetes was noted in these patients. The mean age at admission was 29.8 ± 22.2 years, ranging from 17 months to 54 years. The sex-ratio (M/F) was 4/3. All patients showed neuroglycopenic signs. A prolonged supervised fast was performed in 5 patients, confirmed the presence of hypoglycemia. Eiologies were various: the diagnosis of adrenal insufficiency was established in 2 patients (17-month-old infant and 4-year-old child). A benign insulinoma was noted in one patient and a malignant insulinoma with extensive liver metastases in one patient with persistent hypoglycemia after surgery, motivating the use of everolimus at a dose of 10 mg/day. The diagnosis of functional hypoglycemia was concluded in 3 patients, secondary to somatostatin-analogues treatment in one acromegalic patient, one case of prediabetes, and in one patient an abnormal-regulation of carbohydrate metabolism was observed.

Discussion and conclusion

Recently, Non-diabetic hypoglycemia are classified according to the clinical condition of the patient: well or ill appearing individual. Biological exploration should be done at the time of spontaneous development of symptoms. If this is not possible, it can be done during a prolonged supervised fast test (up to 72 hours), which constitute the gold standard for diagnosis and etiological orientation. The etiological investigation includes searching for an insulinoma, the most frequent tumor responsible for hypoglycemia in adults, which requires an echo-endoscopy and pancreatic CT-scan.The treatment is initially based on the correction of acute hypoglycemia according to the patient’s state of consciousness. Either by 15 to 20 g of glucose orally if patient is conscious or by intravenous administration of glucose serum if patient is unconscious. after correction, the treatment is etiologic.