title: Persistent hypoglycemia of unknown etiology in a patient without diabetes: a case report and review.
abstract: OBJECTIVE
  This case report reviews the presentation, evaluation, and treatment of persistent hypoglycemia in a patient without a history of diabetes. The use of laboratory tests to differentiate between drug-induced and disease-induced hypoglycemia is reviewed.
  
  
  CONCLUSIONS
  A 51-year-old female with multiple medical conditions including bipolar disorder and no history of diabetes was admitted for evaluation and treatment of hypoglycemia. Pharmacotherapy included intravenous dextrose infusions and bolus doses. A battery of tests was ordered to evaluate intrinsic and extrinsic causes. Endocrine Society guidelines for hypoglycemia exist and have recommendations for testing and strategies to rule out drug-related causes. Her insulin level was 57 IU/mL (normal range < 17). Her proinsulin level was 356.8 pmol/L (normal range <8.8).
  
  
  CONCLUSIONS
  The guidelines recommend a battery of laboratory tests; however, the results are not rapidly available necessitating a structured follow-up process. In our patient, exposure to hypoglycemic agents and exogenous insulin can be ruled out. Autoimmune hypoglycemia or a hypoglycemic reaction to one of her home medications is very unlikely, but cannot be ruled out. An insulinoma is the most likely etiology of her hypoglycemia, but that cannot be confirmed.
authors: Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy Athens, GA 31904, USA. bryanwhite_2002@yahoo.com
authors: Bryan P
authors: BP
authors: White
authors: Robin
authors: R
authors: Southwood
mesh_terms: D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D003920:Diabetes Mellitus; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis*; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D008875:Middle Aged
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents