Non-Diabetic Hypoglycemia

Posted by e-Medical PPT Wednesday, July 25, 2012
Hypoglycemia: case based
Diagnostic approach to hypoglycemia
Iatrogenic hypoglycemia
Tumor-associated hypoglycemia

Hypoglycemia: Symptoms
Sympathoadrenal:
diaphoresis, warmth, anxiety, tremor, nausea, hunger, palpitations/tachycardia
Neuroglycopenic:
Fatigue, dizziness, H/A, visual disturbance, drowsiness, difficulty speaking, inability to concentrate, amnesia, abnormal behaviour, mood changes, loss of consciousness, seizure, focal neurological deficit

Hypoglycemic Disorders
Fasting vs. Post-prandial
Appearance: healthy vs. sick
Hyper-insulinemic vs. Hypo-insulinemic

Non-insulinoma pancreatogenous hypoglycemia (NIPHS)
 Adult nesidioblastosis (islet hypertrophy)
 Postprandial severe neuroglycopenia
 72h fast negative
 Rare, M > F (insulinoma F > M)
 Ca+ stimulation test
 Rx: partial pancreatectomy
   
Insulinoma
Rare neuroendocrine tumor of pancreas
4 cases/million person-years
Originating outside pancreas: 1-2 cases reports only (cervical cancer)
59% female
Most (80-90%) benign
Sporadic or part of MEN-1
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