Abstract

Reactive hypoglycemia caused by an insulinoma, pre-diabetic metabolic state, fluctuations in diabetic metabolic situation and antidiabetic medication is commonly known. We report on the case of an unusual multi-factorial occurrence of a woman with recurrent hypoglycemia, which cannot be explained adequately by a single commonly known cause. We refer to a cachectic non-diabetic 52-year-old German woman, admitted to our clinic for clarification of an insulinoma. The possibility of an insulinoma could be excluded as well as co-morbidities linked to non-diabetic hypoglycemia like sepsis, alcohol dependence liver disease, cancer or self-harm with hypoglycaemic agents. However, our diagnostics revealed a corticotrophic insufficiency as a result of longtime cortisol medication. Still, further causes have additionally to be considered, including dysfunctional elimination of glucose, renal and hepatic gluconeogenesis and glucose regulation on dialysis. These reasons are assumed as the pathological factors. Although insulinoma is a possible cause of hypoglycemia, it is not the only pathogenesis. Here, various alternatives factors are defined, examined and in part treated specifically. As therapy, besides nutritional counselling, the patient received cortisol. After a 20 month follow-up symptoms of symptomatic hypoglycemia were absent. Key words: Case report, hypoglycemia, chronic kidney disease, corticotrophic insufficiency, epileptic seizure.

Highlights

  • Recurrent hypoglycemia can lead to a life-threatening event with severe health complications, including autonomic symptoms like addephagia, nausea, emesis, bleeding, tachycardia, hypertension, tremor, agitation and neuroglycopenic symptoms like dizziness, disorientation, slurred speech, convulsion, headache until coma and death

  • The following knowledge exists about the pathogenesis of hypoglycemia: 1. Current studies lead to the conclusion that human kidney plays an important role in the regulation of glucose homeostasis, by making more gluconeogenesis than ever presumed, taking up glucose from the blood circulation and by reabsorbing glucose from the glomerular filtrate (Mitrakou, 2011)

  • The synopsis of all diagnostic findings, after excluding the opinions of insulinoma, toxicological reasons, a positive family history, an extrapancreatic neoplasm, severe liver disease nor radiological signs of malignancy, shows a relevant recurrent hypoglycemia according to a multisystem involvement

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Summary

Introduction

Recurrent hypoglycemia can lead to a life-threatening event with severe health complications, including autonomic symptoms like addephagia, nausea, emesis, bleeding, tachycardia, hypertension, tremor, agitation and neuroglycopenic symptoms like dizziness, disorientation, slurred speech, convulsion, headache until coma and death. A positive diagnosis of hypoglycemia is defined with venous blood glucose level < 0.55 g/L (or < 3 mmol/L) during the symptoms. The presence of the socalled Whipple’s triad is considered positive, if biochemical hypoglycemia (blood glucose level

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