Endocrine Abstracts

In our presentation we would like to demonstrate a complex case with severe spontaneous long-lasting hypoglycaemic episodes that were observed for more than 48-hours. Later the continuous parenteral glucose need was promptly ceased. A 78-years-old hypertensive non-diabetic patient came to our hospital with hypoglycaemic coma. His unconsciousness were cured prehospitally by parenteral glucose replacement. However hypoglycaemic comas (GCS 1-2-1) were observed several times in the ER and upon admission so he were treated by intravenous glucose perfusor. In the first 24-hours he needed 420 grams (!) of glucose intravenously to avoid unconsciousness and to maintain the patient’s blood glucose level around 3-4 mmol/l. Unsuppressed, moreover elevated serum insulin and C-peptide levels were measured simultaneously with the hypoglycaemic episodes. Our patient was in good physical condition, he was neither obese nor malnourished. He negated any alcohol and antidiabetic drug consumptions despite multiple interrogations. His wife had T2DM but she was on fix dose combination of metformin and vildagliptin. Staging CT and abdominal MRI scans did not revealed any obvious malignancy nor insulinoma or any GEP-NET-like alteration. On the third observational day our patient’s parenteral glucose need started to decreased and later it ceased. Therefore a casualty of sulfonylurea abuse was clinically assumed, so we sent blood and urine samples to the laboratory of toxicology for sulfonylurea derivates. The findings showed 87, 5 ng/ml gliclazide in the blood and traces of gliclazide from the urine with liquid chromatography and tandem mass spectrometry which could also be an artefact. Once we received these results we asked again the patient and his family whether they had ever taken gliclazide on its marketed brand names. Then they confirmed that they had gliclazide in their home, although it was prescribed only for his wife’s peri-contrast media days despite metformin and they proved that only those 4 pills were missing. Thus, we dared to perform a 72-hours fasting test which ended with a negative result, consequently the likelihood of insulinoma finally could be excluded. We asked the family to keep the above mentioned unnecessary drug far away from our patient and from his wife to avoid similar accidents. The patient was discharged but he needs further urologic and cardiologic follow up due to elevated PSA levels and sinus bradycardia with left bundle branch block.