| Insulinoma in a Patient with Normal Results from Prolonged fast and Glucagon-induced Hypoglycemia. | |
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MedLine Citation:
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PMID: 20570814 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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Objective: To describe a man with a functioning in-sulinoma and normal results from two 72-hour fasts who developed hypoglycemia secondary to exaggerated insulin response following glucagon stimulation.Methods: We report the patient's clinical findings, laboratory findings, and clinical course. We also review the literature for previously reported cases and possible mechanisms.Results: A 49-year-old man presented with hypogly-cemic symptoms initially occurring after jogging and well-documented symptomatic hypoglycemia occurring during an evening meal. A 72-hour fast was associated with a serum glucose concentration of 50 mg/dL, suppressed insulin and C-peptide levels, and mildly elevated β-hydroxybutyrate. Another documented episode of hypoglycemia occurring 3 hours postprandially was associated with elevated insulin and C-peptide and suppressed β-hydroxybutyrate. A second 72-hour fast provoked asymptomatic hypoglycemia (glucose concentration at 60 hours: 32 mg/dL) with suppressed insulin and measurable β-hydroxybutyrate. After 72 hours of fasting, glucagon administration led to a decrease in glucose from 50 to 18 mg/dL, elevations in insulin and C-peptide, and suppression of β-hydroxybutyrate. Computed tomography revealed a mass lesion in the pancreatic tail. Distal pancreatectomy was performed, and the resected specimen demonstrated immunostaining for insulin. Hypoglycemic symptoms resolved postoperatively.Conclusions: Normal results from a prolonged fast do not preclude an insulinoma and may demonstrate exaggerated insulin secretion from the insulinoma following glucagon administration. In addition to examining the glucose response to glucagon as a surrogate for insulinoma diagnosis, measurement of serum insulin levels following glucagon administration may provide a further clue to the diagnosis of insulinoma. |
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Authors:
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Abel Wah Ek Soh; Peng Chin Kek |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists Volume: 16 ISSN: 1934-2403 ISO Abbreviation: Endocr Pract Publication Date: 2010 Sep-Oct |
Date Detail:
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Created Date: 2011-03-01 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9607439 Medline TA: Endocr Pract Country: United States |
Other Details:
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Languages: eng Pagination: 838-41 Citation Subset: IM |
Affiliation:
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Department of Endocrinology, Singapore General Hospital, Singapore. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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