Endocrine Abstracts

Idiopathic ketotic hypoglycaemia is cited as the most frequent cause of hypoglycaemia in childhood but is a rare phenomenon in adults. We present the case of a 72 year man without diabetes presenting to the emergency department with spontaneous symptomatic hypoglycaemia with a glucose of 2.2 mmol/l. On admission he had a normal pituitary profile, negative insulin antibodies, a normal short synacthen test, a negative urine and serum sulphonylurea screen and a normal IGF-II and IBF BP3. A collateral history revealed he had lost weight in the months preceding admission and frequently skipped meals. The day prior to admission he had eaten less than usual and gone on a long walk He underwent a 72 hour fast as an inpatient during which time his blood glucose dropped to 2.8 mmol/l after 48 hours with an appropriately suppressed insulin, C-peptide and pro-insulin. Interestingly his beta hydroxybutyrate level was undetectably high at >5 mmol/l. His blood glucose normalised with refeeding and he was discharged with a glucometer and education from a diabetes nurse specialist. Following discharge this gentleman went on to have a prolonged oral glucose tolerance test which revealed some mild post prandial hypoglycaemia which was also felt to be a contributing factor to his presentation. He was diagnosed as having idiopathic ketotic hypoglycaemia and mild reactive post prandial hypoglycaemia. He was followed for an 18 month period during which time he was advised to eat more frequent meals and avoid periods of prolonged starvation which lead to complete resolution of his hypos and he was subsequently discharged from clinic without issue.