title: [Clinical approach of a suspicion of hypoglycaemic malaise in a nondiabetic adult].
abstract: Malaises are often attributed to hypoglycaemia in nondiabetic people who don't have any other serious medical problem. However, such a diagnosis is often overused, because not really demonstrated in most instances. The diagnosis of hypoglycaemia should be structured, based upon the Whipple triad. First, the anamnesis must search for adrenergic and neuroglucopenic symptoms that suggest hypoglycaemia. Afterwards, hypoglycaemia must be authentified by a measurement of a low glucose level at the time of a malaise. Finally, if the malaise is due to a hypoglycaemia, it should resume rapidly after the administration of sugar. When the diagnosis is made based upon this triad, the medical interview should precise the severity of the symptoms and focus on the chronology of the malaises, after meal or in the fasting state, which is crucial to differentiate functional reactice hypoglycaemia from hypoglycaemia due to an insulinoma. Finally, additional medical examinations may be performed, first based upon clinical biology followed, if necessary, by medical imaging. They will not only confirm the diagnosis of hypoglycaemia, but also contribute to find the cause of hypoglycaemia, which will help in choosing the therapeutic strategy.
authors.affiliation: Service de Diabétologie, Nutrition et Maladies métaboliques et Unité de Pharmacologie clinique, CHU site Sart Tilman, Liège, Belgique.
authors.forename: A J
authors.initials: AJ
authors.lastname: Scheen
authors.affiliation: Service de Diabétologie, Nutrition et Maladies métaboliques, CHU site Sart Tilman, Liège, Belgique.
authors.forename: N
authors.initials: N
authors.lastname: Paquot
authors.affiliation: Université de Liège, Belgique.
authors.forename: P J
authors.initials: PJ
authors.lastname: Lefèbvre
mesh_terms: D000328:Adult; D000465:Algorithms; D003663:Decision Trees; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis* / Q000209:etiology; D007340:Insulinoma / Q000150:complications / Q000175:diagnosis*; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis*; D013575:Syncope / Q000175:diagnosis* / Q000209:etiology
keywords:  Diagnosis ;  Dizziness ;  Fasting ;  Hypoglycaemia ;  Postprandial