Endocrine Abstracts

This is a case of a 38-year-old lady with a past medical history of Ehlers Danlos Syndrome, functional neurological syndrome and unremarkable cardiac investigations for palpitations. She was referred by her general practitioner (GP) with episodic shaking, excessive sweating, recurrent hypo-and hyperglycaemia recorded by her own capillary blood glucose (CBG) meter, ranging from 1.9mmol/l to 19mmol/l. The episodes would mostly occur 1 to 3 times per week, usually in the afternoon and last for approximately 15 minutes. She denied loss of consciousness and the episodes would leave her feeling either weak or fine. All her medications (Duloxetine, bisoprolol and oral contraceptive pill) were stopped prior to her endocrine appointment. She was admitted following recurrent hypoglycaemia and with presenting symptoms suggestive of urinary tract infection. She had various investigations including a normal IGF-1, coeliac screen, a short synacthen test (SST) with 0, 30 and 60mins serum cortisol response of 452, 658 and 820 respectively, normal 24 hr urine metanephrine and a 72 hour fast which did not reveal any spontaneous hypoglycaemia. Subsequent prolonged oral glucose tolerance test (OGTT) was indicative of Type2 Diabetes Mellitus with a CBG at 0 mins of 6.3 and at 120 mins of 12.1mmol/l. She experienced symptoms of headache, tiredness and sweating at 240 mins with a CBG of 3.5mmol/l. The patient has continued to experience hypoglycaemic episodes in daily life. She has therefore been advised to have smaller meal portions but more frequent intake which she reports have reduced her hypoglycaemia episodes.

Conclusion: Reactive hypoglycaemia could be a cause of recurrent hypoglycaemia in individuals with or without diabetes mellitus. Reactive hypoglycaemia can be a debilitating condition with a significant impact on one’s general wellbeing and daily activities. Diagnosing and understanding of reactive hypoglycaemia would potentially change one’s life for the better.