title: Screening for sulphonylureas in the investigation of hypoglycaemia.
abstract: The most important cause of hypoglycaemia in the presence of high insulin and C-peptide concentrations is insulinoma. However, a similar picture arises from use of sulphonylureas, which is sometimes covert. All specimens received in two years by a supraregional assay service laboratory from adults with low glucose and inappropriately high insulin and C-peptide concentrations were tested for sulphonylureas by a radioimmunoassay that employed antibodies to glibenclamide. In sulphonylurea-positive cases a questionnaire was sent to the consultant responsible for the patient, to elicit further information. Samples from 93 adult patients met the criteria, and 34 (37%) of these gave a positive result on screening for sulphonylureas. The consultants provided further information on 31 of the 34, and in 20 the presence of a sulphonylurea was unexpected. In 10 the features were such as to raise the possibility of factitious drug ingestion. A simple screening technique applied to specimens from patients with hyperinsulinaemic hypoglycaemia indicated that, in a substantial proportion of cases, the patient was taking a sulphonylurea.
authors.affiliation: SAS Hormone Laboratory, Clinical Laboratory, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK. pandina.kwong@rbhc-tr.nthames.nhs.uk
authors.forename: P Y P
authors.initials: PY
authors.lastname: Kwong
authors.forename: J D
authors.initials: JD
authors.lastname: Teale
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002096:C-Peptide / Q000097:blood; D002648:Child; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis* / Q000209:etiology; D007328:Insulin / Q000097:blood; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D011863:Radioimmunoassay / Q000379:methods; D012680:Sensitivity and Specificity; D013453:Sulfonylurea Compounds / Q000097:blood*
chemical_list: D015415:Biomarkers; D002096:C-Peptide; D007328:Insulin; D013453:Sulfonylurea Compounds