Ferreira Ana Isabel, Serino Barbosa Mariana, Coelho Rita, Lourenço Patrícia
Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal.
Department of Pneumology, Centro Hospitalar Universitário de São João, Porto, Portugal.
Eur J Case Rep Intern Med. 2020 Jul 24;7(10):001827. doi: 10.12890/2020_001827. eCollection 2020.
Hypoglycaemia is rare in apparently well patients without drug-treated diabetes mellitus and warrants evaluation and management when Whipple's triad is present. Even in the absence of Whipple's triad, when repeatedly low values of plasma glucose are documented, the presence of endogenous hyperinsulinism should be investigated. The authors describe a case of endogenous hypoglycaemic hyperinsulinism, its diagnosis and treatment and the challenges of determining its aetiology.
A high degree of suspicion is necessary when a hospitalized, apparently well, patient presents with episodes of hypoglycaemia with no apparent cause.Documented repeated low glucose values (<40-55 mg/dl) warrant investigation even when Whipple's triad is absent.The diagnosis, approach and treatment of endogenous hypoglycaemic hyperinsulinism is challenging and requires persistence, particularly if examinations fail to show the responsible lesion.
低血糖在无药物治疗的糖尿病且表面健康的患者中很少见，当出现Whipple三联征时需要进行评估和处理。即使没有Whipple三联征，当血浆葡萄糖值反复偏低时，也应调查是否存在内源性高胰岛素血症。作者描述了一例内源性低血糖性高胰岛素血症病例、其诊断和治疗以及确定病因所面临的挑战。
对于住院的、表面健康但无明显原因出现低血糖发作的患者，必须高度怀疑。即使没有Whipple三联征，记录到反复的低血糖值（<40 - 55 mg/dl）也需要进行调查。内源性低血糖性高胰岛素血症的诊断、方法和治疗具有挑战性，需要坚持不懈，尤其是在检查未能发现责任病变的情况下。
