[Successful pharmacological treatment of hyperinsulinemic hypoglycemia with verapamil and amlodipine--case report].
We present a case of an 80-years-old female patient admitted to hospital because of recurrent losses of consciousness due to hypoglycemia, and because of hypertension. In view of the clinical picture (Whipple's triad) a suspicion of hypoglycemia due to an insulinoma of the pancreas aroused. The suspicion was confirmed by a positive fast test. The test was terminated after 22 hours with a glucose concentration of 2.0 mmol/l (36 mg/dl) and an insulin level of 16.19 microU/ml. No visual diagnostic was performed due to the lack of the patient's consent, thus no diagnosis of a tumor of the pancreas could be established. Hypertension was controlled with two calcium channel inhibitors: verapamil and amlodipine were administered orally, in doses of 120 mg and 10 mg per day, respectively. Both medications were chosen because of intolerance to other anti-hypertensive agents. During two-weeks treatment an increase of glucose concentrations and no hypoglycemic symptoms were observed. The patient did not agree to surgical intervention and therefore she was discharged in good general condition.


CONCLUSIONS
we observe the efficacy of verapamil and amlodipine administered simultaneously in the medical treatment of endogenous hyperinsulinemic hypoglycemia. Their efficacy in the medical treatment of insulinoma requires further research.
Owecki
Maciej
M
Katedra i Klinika Endokrynologii, Przemiany Materii i Chorób Wewnetrznych Akademii Medycznej, Poznaniu. mowecki@amp.edu.pl
Sowiński
Jerzy
J
D000369:Aged, 80 and over; D017311:Amlodipine / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006946:Hyperinsulinism / Q000150:complications* / Q000209:etiology; D006973:Hypertension / Q000188:drug therapy; D007003:Hypoglycemia / Q000188:drug therapy* / Q000209:etiology; D007340:Insulinoma / Q000150:complications* / Q000378:metabolism; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000378:metabolism; D016896:Treatment Outcome; D014700:Verapamil / Q000627:therapeutic use*
D002121:Calcium Channel Blockers; D017311:Amlodipine; D014700:Verapamil