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非糖尿病患者的自发性低血糖：诊断与治疗难题

Spontaneous Hypoglycemia in a Non-diabetic Patient: A Diagnostic and Therapeutic Conundrum.

作者信息

Mahendiran Karnika, Moorthy Swathy, M Lakshmi, Bhaskar Emmanuel

机构信息

Internal Medicine, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND.

出版信息

Cureus. 2024 Jul 26;16(7):e65467. doi: 10.7759/cureus.65467. eCollection 2024 Jul.

DOI:10.7759/cureus.65467
PMID:39188435
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11345124/
Abstract

Hypoglycaemia is a medical emergency requiring an immediate intervention to prevent neuroglycopenic symptoms such as confusion, seizures, and coma. While evaluating for the cause of hypoglycemia, after excluding common causes like insulin use or sepsis, other causes involving endogenous hypoglycemia need to be evaluated. A cause to be considered is nesidioblastosis. This rare entity is also known as non-insulinoma pancreatogenous hypoglycemia syndrome. There have been instances where this disorder has been mistaken as insulinoma due to the characteristics shared by the two. Here, we present a case of a non-diabetic male experiencing symptoms of giddiness and palpitations for the past two years who had been extensively evaluated to rule out insulinoma and was diagnosed with nesidioblastosis.

摘要

低血糖是一种医疗急症，需要立即进行干预以预防神经低血糖症状，如意识模糊、癫痫发作和昏迷。在评估低血糖的病因时，排除胰岛素使用或败血症等常见病因后，需要评估其他涉及内源性低血糖的病因。其中一个需要考虑的病因是胰岛细胞增殖症。这种罕见的病症也被称为非胰岛素瘤胰源性低血糖综合征。由于两者具有共同特征，这种病症曾有被误诊为胰岛素瘤的情况。在此，我们报告一例非糖尿病男性病例，该患者在过去两年中出现头晕和心悸症状，经过广泛评估以排除胰岛素瘤，最终被诊断为胰岛细胞增殖症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e22d/11345124/044b639a68a1/cureus-0016-00000065467-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e22d/11345124/7523dae9c6a9/cureus-0016-00000065467-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e22d/11345124/057dfa625831/cureus-0016-00000065467-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e22d/11345124/8d957ee3bbba/cureus-0016-00000065467-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e22d/11345124/044b639a68a1/cureus-0016-00000065467-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e22d/11345124/7523dae9c6a9/cureus-0016-00000065467-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e22d/11345124/057dfa625831/cureus-0016-00000065467-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e22d/11345124/8d957ee3bbba/cureus-0016-00000065467-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e22d/11345124/044b639a68a1/cureus-0016-00000065467-i04.jpg

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本文引用的文献

1
Diffuse, Adult-Onset Nesidioblastosis/Non-Insulinoma Pancreatogenous Hypoglycemia Syndrome (NIPHS): Review of the Literature of a Rare Cause of Hyperinsulinemic Hypoglycemia.弥漫性成人起病的胰岛细胞增殖症/非胰岛素瘤性胰源性低血糖综合征（NIPHS）：高胰岛素血症性低血糖罕见病因的文献综述
Biomedicines. 2023 Jun 16;11(6):1732. doi: 10.3390/biomedicines11061732.
2
Adult-onset nesidioblastosis: a challenging diagnosis revealed by glucagon-like-peptide-1 receptor imaging.成人隐匿性自身免疫性糖尿病：胰高血糖素样肽-1受体显像揭示的具有挑战性的诊断
Endocrinol Diabetes Metab Case Rep. 2022 Nov 1;2022. doi: 10.1530/EDM-22-0325.
3
Insulin Autoimmune Syndrome (Hirata Disease): A Comprehensive Review Fifty Years After Its First Description.
胰岛素自身免疫综合征（平田病）：首次描述五十年后的综合综述
Diabetes Metab Syndr Obes. 2020 Apr 1;13:963-978. doi: 10.2147/DMSO.S219438. eCollection 2020.
4
Endogenous hyperinsulinism: diagnostic and therapeutic difficulties.内源性高胰岛素血症：诊断与治疗难题
Pan Afr Med J. 2019 May 27;33:57. doi: 10.11604/pamj.2019.33.57.18885. eCollection 2019.
5
Nesidioblastosis in adults.成人胰岛细胞瘤。
Neoplasma. 2014;61(3):252-6. doi: 10.4149/neo_2014_047.
6
Diagnosis and management of insulinoma.胰岛素瘤的诊断与治疗。
World J Gastroenterol. 2013 Feb 14;19(6):829-37. doi: 10.3748/wjg.v19.i6.829.
7
Electrical short-circuit in β-cells from a patient with non-insulinoma pancreatogenous hypoglycemic syndrome (NIPHS): a case report.非胰岛素瘤胰腺源性低血糖综合征（NIPHS）患者β细胞中的电短路：一例报告
J Med Case Rep. 2010 Sep 23;4:315. doi: 10.1186/1752-1947-4-315.
8
Hyperinsulinemic hypoglycemia with nesidioblastosis: histologic features and growth factor expression.伴胰岛细胞增殖症的高胰岛素血症性低血糖症：组织学特征及生长因子表达
Mod Pathol. 2009 Feb;22(2):239-45. doi: 10.1038/modpathol.2008.169. Epub 2008 Oct 17.
9
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J Gastrointest Surg. 1998 Sep-Oct;2(5):473-82. doi: 10.1016/S1091-255X(98)80039-5.
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Hum Pathol. 2008 Jan;39(1):3-8. doi: 10.1016/j.humpath.2007.09.010.