Pre- and postoperative glucose levels for eliciting hypoglycaemic responses in a patient with insulinoma.
Counterregulatory hormones and hypoglycaemic symptoms were studied during a gradual decline in plasma glucose in a 66-year-old man before and 9 weeks after removal of an insulin-producing tumour. Before surgery the adrenaline started to respond first at plasma glucose 2.8 mmol l-1. He reported no autonomic symptoms although plasma glucose fell to 2.3 mmol l-1 with a corresponding adrenaline rise to 4.64 nmol l-1. After surgery adrenaline responded at a plasma glucose of 3.7 mmol l-1 and he started to sweat and tremble at a plasma glucose of 3.1 mmol l-1 (corresponding adrenaline 2.63 nmol l-1). The lack of autonomic symptoms preoperatively may indicate adrenaline insensitivity, possibly as a result of repeated hypoglycaemia.
Vea
H
H
Department of Internal Medicine, University Hospital of Tromsø, Norway.
Jorde
R
R
Sager
G
G
Vaaler
S
S
Sundsfjord
J
J
Revhaug
A
A
D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D004837:Epinephrine / Q000097:blood*; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007003:Hypoglycemia / Q000209:etiology*; D007328:Insulin; D061389:Insulin, Regular, Pork; D007340:Insulinoma / Q000097:blood* / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000503:physiopathology / Q000601:surgery*
D001786:Blood Glucose; D007328:Insulin; D061389:Insulin, Regular, Pork; C000006:insulin, neutral; D006854:Hydrocortisone; D004837:Epinephrine