Manjunath P R, George Belinda, Mathew Vivek, Bantwal Ganapathi, Ayyar Vageesh
Department of Endocrinology, St. John's Medical College, Bengaluru, Karnataka, India.
Indian J Endocrinol Metab. 2017 Sep-Oct;21(5):655-659. doi: 10.4103/ijem.IJEM_174_17.
Endogenous hyperinsulinemic hypoglycemia (EHH) is a condition in which the insulin levels are inappropriately high in the presence of low plasma glucose.
We did a retrospective analysis of case records of those patients admitted and evaluated for EHH from June 2004 to June 2016 in our center, excluding those that were diagnosed with reactive hypoglycemia. We collected data regarding demographics, clinical presentation, laboratory results, localization techniques, and treatment administered.
Sixteen patients who were admitted for evaluation based on history suggestive of repeated hypoglycemic episodes were included in the study. All but one pregnant patient was subjected to a supervised fast in the hospital. All patients developed hypoglycemia (defined using Whipple's triad) within the first 24 h. Three patients had autoimmune hypoglycemia which differed significantly from insulinoma-mediated hypoglycemia in certain clinical and laboratory parameters. They were older in age with marked fluctuations in the 24 h glucose profile ranging from frank hypoglycemia to frank hyperglycemia. The insulin levels were markedly elevated in this group of patients along with a significantly elevated insulin C peptide molar ratio (ICMR) when compared with patients with insulinoma-mediated hypoglycemia.
Although insulinoma is the most common cause of EHH, autoimmune hypoglycemia should be considered as a differential diagnosis, particularly in older individuals with plasma glucose values increasing to the hyperglycemic range. Degree of elevation of insulin levels and ICMR may provide additional clues. Overall, the survival and prognosis of patients with EHH are excellent.
内源性高胰岛素血症性低血糖症（EHH）是一种在血浆葡萄糖水平较低时胰岛素水平却异常升高的病症。
我们对2004年6月至2016年6月期间在本中心因EHH入院并接受评估的患者病历进行了回顾性分析，排除了那些被诊断为反应性低血糖症的患者。我们收集了有关人口统计学、临床表现、实验室检查结果、定位技术和所给予治疗的资料。
本研究纳入了16例因有反复低血糖发作病史而入院接受评估的患者。除一名孕妇外，所有患者均在医院接受了监督下的禁食。所有患者在最初24小时内均出现低血糖（根据惠普尔三联征定义）。3例患者患有自身免疫性低血糖症，在某些临床和实验室参数方面与胰岛素瘤介导的低血糖症有显著差异。他们年龄较大，24小时血糖曲线波动明显，从明显低血糖到明显高血糖。与胰岛素瘤介导的低血糖症患者相比，这组患者的胰岛素水平明显升高，胰岛素C肽摩尔比（ICMR）也显著升高。
虽然胰岛素瘤是EHH最常见的病因，但自身免疫性低血糖症也应被视为鉴别诊断，尤其是在血浆葡萄糖值升高至高血糖范围的老年个体中。胰岛素水平和ICMR的升高程度可能提供额外线索。总体而言，EHH患者的生存率和预后良好。
