title: Spontaneous hypoglycemia associated with congestive heart failure attributable to hyperinsulinism.
abstract: OBJECTIVE
  To report a case of spontaneous hypoglycemia associated with congestive heart failure in an adult.
  
  
  METHODS
  We describe a 72-year-old man in whom profound hypoglycemia (serum glucose level, 21 mg/dL) developed during an exacerbation of heart failure. Clinical and laboratory data are reviewed.
  
  
  RESULTS
  An inverse relationship was found between both serum insulin and C peptide levels and serum glucose level. Serum glipizide and glyburide levels were undetectable, and no insulinoma was found on radiologic imaging. Hypoglycemia resolved after alleviation of the congestive heart failure.
  
  
  CONCLUSIONS
  In this case, the hypoglycemia was attributed to hyperinsulinemia. Possible mechanisms include impaired insulin degradation and shunting of portal blood into the systemic circulation.
authors.affiliation: Memorial Medical Center, Savannah, Georgia, USA.
authors.forename: H
authors.initials: H
authors.lastname: Khoury
authors.forename: T
authors.initials: T
authors.lastname: Daugherty
authors.forename: K
authors.initials: K
authors.lastname: Ehsanipoor