Spontaneous hypoglycemia: diagnostic evaluation and management

  title={Spontaneous hypoglycemia: diagnostic evaluation and management},
  author={Leelavathy Kandaswamy and Rajeev Raghavan and Joseph M Pappachan},
Spontaneous hypoglycemia is a puzzling clinical problem and an important reason for referral to endocrinologists. Several clinical conditions such as insulinomas, non-insulinoma pancreatogenous hypoglycemia syndrome, insulin autoimmune syndrome, postprandial hypoglycemia (reactive hypoglycemia), non-islet cell tumor hypoglycemia, primary adrenal insufficiency, hypopituitarism, and critical illness can be associated with spontaneous hypoglycemia. Rarely, in patients with mental health issues… 
Spontaneous hypoglycemia: a review
Irrespective of the exact cause of the spontaneous hypoglycemia, treatment consists of correcting the glycemic state and preventing recurrence by alleviating underlying pathology.
[Reactive hypoglycemia - an interdisciplinary approach of the disease of XXI Century].
Existing knowledge about reactive hypoglycemia - etiology, diagnostic model and treatment is summarized to summarize.
Tumour-induced hypoglycaemia: a narrative review
There are two main groups of TIH: insulinoma and non-islet cell tumours (NICTs), and accurate diagnosis of Insulinoma versus NICTs provides a rationale for effective and individually tailored management.
Insulin-induced autoimmune syndrome: A case report.
In patients with repeated hypoglycemia, IAS should be considered in the differential diagnosis, and Prednisone may be effective for the treatment of hyp glucosecemia in patients with IAS.
Non-Islet Cell Tumor Hypoglycemia Caused by Recurrent Pelvic Solitary Fibrous Tumor
Non-islet cell tumor hypoglycemia should be considered in the differential diagnosis of patients presenting with tumors and recurrent hypoglycaemia, especially in patients with a history of ovarian solitary fibrous tumor.
Nutritional guidelines for the management of insulin resistance.
The aim of this article is to present the most common IR states, namely obesity and Polycystic Ovary Syndrome, and provide nutritional advice to manage IR, hyperinsulinemia, and reactive hypoglycemia that could prevent progression or worsening of IR with resultant beta-cell failure and, as a result, T2D.
The management of neuroendocrine tumours: A nutritional viewpoint
The aim of this review is to provide dietary advices for each specific condition in patients with NETs, underlining the importance of a nutritional approach to treat malnutrition in this setting.
Hypoglycemia secondary to insulinoma masking the onset of type 1 diabetes in an adolescent
Type 1 diabetes and insulinoma can co‐occur in pediatric patients and may present with episodes of hypo‐ and hyperglycemia, significant glycemic variability, and weight gain. Surgical resection leads
Continuous Glucose Monitoring in Patients With Insulinoma Treated by Endoscopic Ultrasound-Guided Ethanol Injection
Investigation of the continuous glucose monitoring profiles of patients with insulinoma before and after treatment with endoscopic ultrasound–guided ethanol injection found that CGM is useful for detecting hypoglycemia and evaluating curative effect, but the correction of fingertipBlood glucose is necessary when the blood glucose is relatively low.
Pancreatic neuroendocrine tumors: contemporary diagnosis and management
This manuscript will review pancreatic neuroendocrine tumor subtypes, syndromes, diagnosis, and clinical management.


Approach to the patient with spontaneous hypoglycemia.
Recurrent Hypoglycemia from Insulin Autoimmune Syndrome
A case of insulin autoimmune syndrome is reported in a Caucasian woman with recurrent complaints of hypoglycemia, with laboratory findings of serum glucose 2.5 mmol/L (45 mg/dL) and autoantibodies to insulin were markedly elevated at > 50 kU/L (> 50 U/mL).
Hypoglycaemia in nondiabetic patients - an evidence.
  • C. Ng
  • Medicine
    Australian family physician
  • 2010
To search for evidence based guidelines on diagnosis and management of hypoglycaemia in nondiabetic adult patients and to see how these guidelines can be applied in general practice, the Endocrine Society clinical practice guideline 2009 is reviewed.
A rare case of adulthood-onset growth hormone deficiency presenting as sporadic, symptomatic hypoglycemia
Hypoglycemia was the main clinical symptom of isolated adult onset GHD, in the present case of a 62- yr-old man, referred for recurrent hypoglycemic events.
Diagnosis and management of insulinoma.
In patients with unresectable or uncontrollable insulinomas, such as malignant insulinoma of the pancreas, several techniques should be considered, including administration of ocreotide and/or continuous glucose monitoring, to prevent hypoglycemic episodes and to improve quality of life.
Autoimmune Forms of Hypoglycemia
The clinical and biochemical characteristics and clinical course of 2 white patients with insulin autoimmune syndrome are reported, and a literature review of non-Asian patients reported with insulinimmune syndrome are presented, to spare a hypoglycemic patient from an unnecessary pancreatic surgical procedure.
Refractory idiopathic non-insulinoma pancreatogenous hypoglycemia in an adult: case report and review of the literature.
This long-term follow-up of non-insulinoma pancreatogenous hypoglycemia treatment in an adult patient indicates that lateral pancreatectomy may not be sufficient for permanent blood glucose control and emphasizes the need of following-up data after subtotal pancreATEctomy.
A case of hypothalamic hypopituitarism accompanied by recurrent severe hypoglycemia
It is recommended to stop hydrocortisone and start prednisolone to sufficiently replace steroid hormone and avoid recurrent hypoglycemia, and to be aware of the possibility of hypothalamic hypopituitarism as a cause of recurrent severe hypglycemia.
Management of endocrine disease: a clinical update on tumor-induced hypoglycemia.
Tumor-induced hypoglycemia (TIH) is a rare clinical entity that may occur in patients with diverse kinds of tumor lineages and that may be caused by different mechanisms, including the eutopic insulin secretion by a pancreatic islet β-cell tumor and the tumor secretion of peptides capable of causing glucose consumption by different mechanism.
Clinical Features and Causes of Endogenous Hyperinsulinemic Hypoglycemia in Korea
The results of this study suggest that the prevalence of IAS may be higher in Korea than previously thought, and measurement of insulin autoantibody levels is warranted for EHH patients, especially in patients with very high plasma insulin levels.