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Endocrine Abstracts (2024) 104 P165 | DOI: 10.1530/endoabs.104.P165

St. James’s Hospital, Dublin, Ireland


Introduction: Unexplained falls are a common rationale for emergency presentations amongst older adults. Admissions are associated with significant morbidity. We present a case series of two older adults presenting following collapse, with resultant diagnosis of insulin-mediated hypoglycaemia.

Case 1: 79 year-old woman presenting following a presyncopal event. In the weeks preceding admission, described lethargy and weight loss, with associated palpitations and tremor. TSH was <0.01mu/l and fT4 60 pmol/l. Random serum glucose was 2.9 mmol/l, without associated symptoms. TSH-Receptor antibody was positive, and a diagnosis of Graves thyrotoxicosis made. Carbimazole 20 mg BD was commenced. A 72-hour fast was undertaken (Table 1), with serum glucose nadir 1.9 mmol/l. Endoscopic ultrasound identified a pancreatic head insulinoma. Diazoxide was commenced, with surgical input and successful resection.

Case 2: 87 year-old woman admitted with an intertrochanteric fracture following a nocturnal fall. Random capillary glucose was 2.7 mmol/l. Notable symptoms included recurrent episodes of diaphoresis and presyncope requiring use of dextrose tablets in the years preceding admission. Fasting serum glucose was 3.5 mmol/l, with normal serum cortisol and HbA1c of 30 mmol/mol. 72-hour fast identified serum glucose of 1.7 mmol/l at 14 hours, with hyperinsulinaemia(Table 2) and full ketone suppression. CT pancreas was unremarkable, however there was subsequent diagnosis of small-cell lung cancer. Diazoxide was commenced. Diagnosis was of presumed insulinoma, given biochemistry and symptom chronicity. IGFII:IGFI ratio was preserved. Further work-up was deferred given prognosis.

Table 1. Summarised results of 72h fast in Case 1.
T=29
Glucose(mmol/l)1.5
Insulin(mU/l)21
C-peptide(ug/l)4.47
Table 2. Summarised results of 72hour fast in Case 2.
T=14
Plasma glucose(mmol/l)1.7
Insulin(mU/l)6.4
C-peptide(ug/l)1.56

Discussion: This case series describes two unexpected diagnoses of insulin-mediated-hypoglycaemia in older adults, as a causative factor in falls presentations. This highlights an unusual underlying pathology of syncopal events, with significant associated morbidity.

Volume 104

Joint Irish-UK Endocrine Meeting 2024

Belfast, Northern Ireland
14 Oct 2024 - 15 Oct 2024

Society for Endocrinology 

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