General Medicine, Luton and Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Luton, UK.
Renal Department, Luton and Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Luton, UK.
BMJ Case Rep. 2021 Jul 23;14(7):e241439. doi: 10.1136/bcr-2020-241439.
We present a case of a 73-year-old woman who developed recurrent hypoglycaemia during a prolonged hospital stay following a mechanical fall. She had a complex history of insulin-treated diabetes mellitus, hypothyroidism, diffuse systemic cutaneous sclerosis, Raynaud's disease, previous breast cancer, Barrett's oesophagus and previous partial gastrectomy for a benign mass. Hypoglycaemia persisted despite weaning of insulin. She had no clinical features of adrenal or pituitary insufficiency with an acceptable cortisol on stopping prednisolone and had an optimal thyroid replacement. A 72-hour fast elicited hypoglycaemia with corresponding low insulin level. Although the C-peptide was detectable, there were no clinical, biochemical or radiological features suggestive of insulinoma. Reactive hypoglycaemia post partial gastrectomy was ruled out based on limited relation of the hypoglycaemia to meals and the low insulin levels. Hydroxychloroquine (HCQ)-induced hypoglycaemia was considered based on previous case reports and the recent literature, with a successful resolution of hypoglycaemia on discontinuation of HCQ.
我们报告了 1 例 73 岁女性患者，在机械性跌倒后长时间住院期间反复发生低血糖。她有复杂的胰岛素治疗糖尿病、甲状腺功能减退症、弥漫性系统性硬皮病、雷诺病、既往乳腺癌、巴雷特食管和既往良性肿块的部分胃切除术病史。尽管逐渐停用胰岛素，但低血糖仍持续存在。她没有肾上腺或垂体功能不全的临床特征，停用泼尼松龙后皮质醇水平可接受，甲状腺功能替代也很理想。72 小时禁食诱发低血糖，同时胰岛素水平相应降低。虽然 C 肽可检测到，但没有临床、生化或影像学特征提示胰岛素瘤。根据低血糖与进餐的有限关系和较低的胰岛素水平，排除了胃部分切除术后反应性低血糖的可能。根据之前的病例报告和最近的文献，考虑了羟氯喹（HCQ）引起的低血糖，并在停用 HCQ 后低血糖得到成功缓解。
