Recidiverende hypoglykemie bij een patiënt zonder diabetes mellitus: een casusbespreking

Abstract

Recurrent hypoglycemia in a patient without diabetes mellitus: a case report Hypoglycemia is an uncommon clinical problem in patients not being treated for diabetes mellitus. The presence of a hypoglycemic disorder in a person without diabetes mellitus should only be suspected in those patients in whom Whipple’s triad is documented. In this case report, the diagnostic exploration of a 79-year-old nondiabetic woman who presented with recurrent deep hypoglycemia, is described. The diagnosis of an insulinoma was established based on extensive laboratory testing (glucose, insulin, C-peptide, beta-hydroxybutyrate, proinsulin and sulfonylurea/meglitinide screening), a provocative fasting test and finally by localizing the tumor by means of magnetic resonance imaging. An insulinoma is a rare pancreatic islet cell tumor which may cause endogenous hyperinsulinism with frequent life-treating hypoglycemia, for which surgical enucleation is considered to be the therapy of choice. This case highlights the challenges endocrinologists face in the differential diagnosis of endogenous hyperinsulinism.