title: Severe hypoglycemia in a patient with anorexia nervosa.
abstract: OBJECTIVE
  Severe hypoglycemia is an important but uncommon complication of anorexia nervosa. A 35-year-old woman showed severe hypoglycemia after a recovery from severe liver dysfunction due to malnutrition.
  
  
  METHODS
  To reveal the cause of severe hypoglycemia, we measured plasma hormones and performed a 75g oral glucose loading test.
  
  
  RESULTS
  Fasting serum adrenocorticotropic hormone, cortisol, growth hormone, somatostatin, and active ghrelin were elevated. Serum free triiodothyronine, leptin, and adiponectin were reduced. Plasma glucose fluctuated from 67 to 76 mg/dl after a 75g glucose ingestion, without hyperinsulinemia. Serum growth hormone, somatostatin, and active ghrelin levels were decreased after glucose ingestion. Plasma glucagon levels were increased and remained at high levels at 120 min, and glucose-dependent insulinotropic polypeptide (GIP) levels were continuously and remarkably increased after glucose ingestion.
  
  
  CONCLUSIONS
  We observed a strongly reduced sensitivity in glucagon-induced hepatic glycogenolysis, and significantly elevated fasting and postprandial GIP levels, and a defective GIP-mediated glucagon secretion, in an anorectic patient with severe hypoglycemia.
authors.affiliation: Department of Internal Medicine, The Jikei University School of Medicine, Chiba 277- 8567, Japan. yanaih@jikei.ac.jp
authors.forename: H
authors.initials: H
authors.lastname: Yanai
authors.forename: H
authors.initials: H
authors.lastname: Yoshida
authors.forename: Y
authors.initials: Y
authors.lastname: Tomono
authors.forename: N
authors.initials: N
authors.lastname: Tada
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000097:blood / Q000150:complications*; D001786:Blood Glucose / Q000378:metabolism; D005260:Female; D005749:Gastric Inhibitory Polypeptide / Q000097:blood*; D005934:Glucagon / Q000378:metabolism; D006728:Hormones / Q000097:blood; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology*; D008107:Liver Diseases / Q000209:etiology; D008111:Liver Function Tests
chemical_list: D001786:Blood Glucose; D006728:Hormones; D005749:Gastric Inhibitory Polypeptide; D005934:Glucagon