title: [Hypoglycemia in nondiabetic patients: When is the 72-hour-fast test required and how can it be interpreted?].
abstract: Whereas hypoglycaemia is uncommon in nondiabetic patients, it is a frequent reason for consultation. Hypoglycaemia is confirmed when criteria of Whipple's triad are fulfilled. If a venous sample cannot be collected when hypoglycemia occurs spontaneously, a 72-hour-fast test should be performed firstly to affirm the reality of hypoglycaemia and secondly to make the etiological diagnosis. Before carrying out this long and expensive test, the obvious causes of hypoglycaemia must be ruled out: iatrogenic, severe prolonged undernutrition, liver or renal deficiency, adrenal insufficiency, IGFII or pro-IGFII secreting tumours…At the time of hypoglycemia, plasma insulin≥3mUI/L, C-peptide≥0.6ng/mL, proinsulin≥5pmol/L associated with plasma beta-hydroxybutyrate≤2700μmol/L provide evidence for inappropriate insulin secretion. The lack of hypoglycaemia after a 72-hour-fast test rules out, in the majority of cases, organic hypoglycaemia.
authors.affiliation: CHU Rangueil-Larrey, service d'endocrinologie, maladies métaboliques et nutrition, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France; Université Paul-Sabatier, centre de recherche en cancérologie de Toulouse, Inserm U1037, 2, avenue Hubert-Curien, CS53717, 31037 Toulouse cedex 1, France. Electronic address: vezzosi.d@chu-toulouse.fr.
authors.forename: Delphine
authors.initials: D
authors.lastname: Vezzosi
authors.affiliation: CHU Rangueil-Larrey, service d'endocrinologie, maladies métaboliques et nutrition, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Bennet
authors.affiliation: CHU Rangueil-Larrey, service d'endocrinologie, maladies métaboliques et nutrition, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France.
authors.forename: Solange
authors.initials: S
authors.lastname: Grunenwald
authors.affiliation: CHU Rangueil-Larrey, service d'endocrinologie, maladies métaboliques et nutrition, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France; Université Paul-Sabatier, centre de recherche en cancérologie de Toulouse, Inserm U1037, 2, avenue Hubert-Curien, CS53717, 31037 Toulouse cedex 1, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Caron
mesh_terms: D003663:Decision Trees; D003955:Diagnostic Tests, Routine; D005215:Fasting; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis*; D013997:Time Factors