Hyperinsulinemic hypoglycemia in adults.
The diagnosis of a hypoglycemic disorder requires a high level of suspicion, careful assessment of the patient for the presence of mediating drugs or a predisposing illness, and, where indicated, methodical evaluation on the basis of well-defined diagnostic criteria. The diagnostic burden is heaviest for healthy-appearing persons with episodes of confirmed neuroglycopenia. Our criteria for insulin mediation of hypoglycemia are: plasma insulin >or=18 pmol (ICMA [immunochemiluminometric assay]), C-peptide >or=200pmol/L (ICMA), proinsulin >or=5pmol/L (ICMA), betaOH butyrate,<or=2.7mmol/L and generous (1.4mmol/L) response of plasma glucose to IV glucagon administered when the patient is hypoglycemic. Sulfonylureas, meglitinides and insulin antibodies should be sought in the plasma of any hypoglycemic patient.
John Service
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Division of Endocrinology, Metabolism and Nutrition, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905, USA.
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D002096:C-Peptide / Q000097:blood; D002648:Child; D005215:Fasting; D006801:Humans; D006946:Hyperinsulinism / Q000175:diagnosis / Q000503:physiopathology*; D007003:Hypoglycemia / Q000145:classification / Q000175:diagnosis / Q000209:etiology*; D011384:Proinsulin / Q000097:blood
D001786:Blood Glucose; D002096:C-Peptide; D011384:Proinsulin