Blans M C, Conemans J M, van der Veer J K, Bouter K P
Bosch Medicentrum, afd. Inwendige Geneeskunde, 's-Hertogenbosch.
Ned Tijdschr Geneeskd. 1998 Sep 26;142(39):2154-6.
A 32-year-old woman was admitted with signs of recurrent hypoglycaemia. Within 72 hours hypoglycaemia was successfully provoked by prolonged fasting. Also, blood samples demonstrated high levels of serum insulin and C-peptide and the insulin-glucose ratio was abnormally high. An insulinoma was strongly suspected. However, extensive imaging displayed no tumour in the pancreas. The patient also had extensive psychological and social problems. The psychiatrist suggested a factitious disorder. High serum concentrations of insulin and C-peptide in combination with the psychiatric disorder led to the suspicion of abuse of sulfonylurea derivatives by the patient. This was confirmed by toxicological screening. A patient with unexplained hypoglycaemia, especially if an insulinoma cannot be detected, should be suspected of abusing sulfonylurea derivatives.
一名32岁女性因反复出现低血糖症状入院。在72小时内，通过长时间禁食成功诱发了低血糖。此外，血样显示血清胰岛素和C肽水平升高，胰岛素-葡萄糖比值异常高。强烈怀疑患有胰岛素瘤。然而，广泛的影像学检查未发现胰腺有肿瘤。该患者还存在广泛的心理和社会问题。精神科医生怀疑是做作性障碍。高血清胰岛素和C肽浓度与精神障碍相结合，导致怀疑患者滥用磺脲类衍生物。毒理学筛查证实了这一点。对于不明原因低血糖的患者，尤其是如果未检测到胰岛素瘤，应怀疑其滥用磺脲类衍生物。
