Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz

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Gewählte Publikation:

SHR Neuro Krebs Kardio Lipid Stoffw Microb

Treiber, G.
Hypoglycemia without diabetes.
AUST J CLIN ENDOCR M. 2020; 13(4): 177-181. Doi: 10.1007/s41969-020-00124-7 [OPEN ACCESS]
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Führende Autor*innen der Med Uni Graz: Treiber Gerlies
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Abstract:: Symptoms of hypoglycemia are common and non-specific. Real hypoglycemia without insulin therapy is rare. The diagnosis of hypoglycemia in patients without diabetes requires the presence of the Whipple triad with documented blood glucose <= 55mg/dl, hypoglycemic symptoms and their relief after intake of glucose. A further diagnostic strategy is to replicate conditions in which hypoglycemia would be expected if a hypoglycemic disorder exists. A prolonged supervised fast, which can last as long as 72h, has been the best established and probably most reliable test for the evaluation of hypoglycemia occurring in the food-deprived state. For patients with postprandial hypoglycemia, a mixed-meal test is the preferred provocative procedure. The parallel measurement of plasma glucose, insulin, C-peptide, proinsulin, and ketones helps in the differentiation between insulinoma, factitious administration of insulin and sulfonylureas as well as nesidioblastosis (NIPHS) and hypoglycemia after bariatric surgery. Marked elevation of insulin autoantibodies is indicative for an autoimmune insulin syndrome and the detection of "big" IFG-2 relates to paraneoplastic secretion of this protein in tumor diseases. Localization diagnostics are only carried out when there is evidence of autonomic endogenous hyperinsulinemia. Scintigraphic examinations using Ga-68-labeled exendin-4, an interventional radiological technique, and the selective calcium stimulation test (SACT), can be performed to help the localization of insulinomas. Acute hypoglycemia must be treated by administering glucose. Long-term therapy consists, if possible, of eliminating the triggering cause, nutritional measures, and drug-based inhibition of insulin secretion.
Find related publications in this database (Keywords): Spontaneous hypoglycemia; Hyperinsulinemia; Whipple triad; 72‑; h fast; Insulinoma