Department of General Practice, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong province, 250014, China.
Endocrine. 2023 Apr;80(1):40-46. doi: 10.1007/s12020-022-03268-5. Epub 2022 Dec 2.
Endogenous hyperinsulinemic hypoglycemia (EHH) is an uncommon disease characterized by inappropriately high plasma insulin levels despite low plasma glucose levels. Some rare etiologies can lead to EHH. Correct diagnosis is a prerequisite for treatment. Hence, although challenging, it is crucial for patients with EHH to identify the different causes.
We describe a case series of three patients, all of whom had obvious hypoglycemic symptoms and extraordinary hyperinsulinemia. Their plasma glucose, insulin, and C-peptide levels were tested simultaneously when hypoglycemia occurred. Moreover, other biochemical indices and relevant antibody levels were measured and imaging examinations were conducted.
According to their medical history, physical examination, laboratory results, and imaging findings, the three patients were diagnosed with insulinoma, type B insulin resistance syndrome, and insulin autoimmune syndrome. After precise treatments, hypoglycemia was ultimately eliminated.
Although these diseases have similar symptoms and biochemical abnormalities, the treatment and prognosis are different. The case series presented here highlights the challenges in the differential diagnosis of EHH. An accurate diagnosis is necessary for hypoglycemia treatment.
内源性高胰岛素血症性低血糖（EHH）是一种罕见疾病，其特征是尽管血糖水平低，但血浆胰岛素水平异常升高。一些罕见的病因可导致 EHH。正确的诊断是治疗的前提。因此，尽管具有挑战性，但对于 EHH 患者来说，识别不同的病因至关重要。
我们描述了三例患者的病例系列，这些患者均有明显的低血糖症状和极高的胰岛素血症。当发生低血糖时，同时检测他们的血糖、胰岛素和 C 肽水平。此外，还测量了其他生化指标和相关抗体水平，并进行了影像学检查。
根据病史、体格检查、实验室结果和影像学发现，这 3 例患者被诊断为胰岛素瘤、B 型胰岛素抵抗综合征和胰岛素自身免疫综合征。经过精确的治疗，最终消除了低血糖。
尽管这些疾病具有相似的症状和生化异常，但治疗和预后不同。本文介绍的病例系列强调了 EHH 鉴别诊断的挑战。准确的诊断是低血糖治疗的必要条件。
