title: Increased plasma β-hydroxybutyrate levels during the fasting test in patients with endogenous hyperinsulinaemic hypoglycaemia.
abstract: OBJECTIVE
  The objective of the present study was to determine whether a plasma β-hydroxybutyrate (BOHB) level >2700 μmol/l during the 72-h fasting test is sufficient to rule out the diagnosis of endogenous hyperinsulinaemic hypoglycaemia (EHH).
  
  
  METHODS
  We retrospectively studied BOHB levels in 39 patients with EHH who had undergone a 72-H fasting test to make the diagnosis of EHH, and we compared EHH patients with BOHB levels 2700 MOL/L (group 1), EHH PATIENTS with BOHB levels 2700 MOL/L (group 2) and 59 controls (median glycaemia: 3.2  mmol/l and median BOHB: 6095 μmol/l).
  
  
  RESULTS
  During a 72-h fasting test, nine patients (group 1) had BOHB levels >2700  μmol/l (median 6140 and range 2957-7824) and 30 patients (group 2) had BOHB levels <2700 μmol/l (median 542 and range 0-2607). In group 1, four patients had undergone partial pancreatectomy previously and were evaluated for the recurrence of hypoglycaemia, whereas none of the group 2 patients had been operated. The duration of the fasting test was longer in group 1 than in group 2 (P<0.0001), and at the end of the fasting test, plasma glucose concentrations were not significantly different (P=0.0617), but insulin (P=0.004), C-peptide (P=0.0015) and proinsulin (P=0.0038) levels were significantly lower in group 1 patients than in group 2 patients, suggesting lower insulin secretion and/or impaired glycaemic counter-regulation.
  
  
  CONCLUSIONS
  During a fasting test, a BOHB level >2700 μmol/l is observed in some EHH patients, suggesting that BOHB levels cannot rule out the recurrence of EHH, in particular, after partial pancreatectomy.
authors: Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle Cardiovasculaire et Métabolique, CHU Rangueil-Larrey, 24 Chemin de Pourvouville, TSA 30030, 31059 Toulouse Cedex 9, France.
authors: Alexandre
authors: A
authors: Buffet
authors: Delphine
authors: D
authors: Vezzosi
authors: Jean Christophe
authors: JC
authors: Maiza
authors: Solange
authors: S
authors: Grunenwald
authors: Antoine
authors: A
authors: Bennet
authors: Philippe
authors: P
authors: Caron
mesh_terms: D020155:3-Hydroxybutyric Acid / Q000097:blood*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D002096:C-Peptide / Q000097:blood; D003937:Diagnosis, Differential; D005215:Fasting / Q000097:blood*; D005260:Female; D006801:Humans; D006946:Hyperinsulinism / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D007003:Hypoglycemia / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D007340:Insulinoma / Q000097:blood* / Q000150:complications / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018761:Multiple Endocrine Neoplasia Type 1 / Q000097:blood; D010180:Pancreatectomy / Q000379:methods; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000150:complications / Q000601:surgery; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D002096:C-Peptide; D020155:3-Hydroxybutyric Acid