title: Severe hypoglycemia with endogenous hyperinsulinemia in a nondiabetic hemodialysis patient following parathyroidectomy.
abstract: Insulin resistance and abnormal carbohydrate metabolism is a recognized complication in patients with advanced chronic kidney disease. We describe a rare case of severe hypoglycemia with inappropriate endogenous hyperinsulinemia in a hemodialysis patient following parathyroidectomy for severe secondary hyperparathyroidism. The patient required intravenous dextrose infusions for 3 days to prevent neuroglycopenic symptoms. Extensive workup for hypoglycaemia revealed high C-peptide and insulin levels in the absence of insulinoma. It is postulated that reversal of parathyroid hormone (PTH)-mediated inhibition of insulin secretion, along with large doses of 1,25-dihydroxyvitamin D3 (calcitriol) were responsible for the increase in insulin secretion and consequent hypoglycemia in this patient.
authors.affiliation: Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ravindra
authors.initials: R
authors.lastname: Nikalji
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Bargman
mesh_terms: D006801:Humans; D006946:Hyperinsulinism / Q000209:etiology*; D006962:Hyperparathyroidism, Secondary / Q000601:surgery*; D007003:Hypoglycemia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy / Q000009:adverse effects*; D011379:Prognosis; D006435:Renal Dialysis / Q000009:adverse effects*
chemical_list: D010281:Parathyroid Hormone