RARE CASE OF NONINSULINOMA PANCREATOGENOUS HYPOGLYCEMIA SYNDROME

Аннотация

The most common cause of persistent hyperinsulinemic hypoglycemia is insulinoma. But there is a unique group of patients with noninsulinoma hypoglycemia, situation very rare. Epidemiologic studies have not been conducted for Non Insulinoma Pancreatogenic Hypoglycemia Syndrome (NIPHS), but the condition appears to be much rare than hypoglycemia caused by insulinoma. The aim of the study is to present rare case of Noninsulinoma pancreatogenous hypoglycemia syndrome. Patient, 51 years old white female, admitted to our clinic on March 5, 2017 for elective operative treatment for insulinoma with complaints on symptoms of insulinoma as defined by Whipple’s triad: 1. hypoglycemia during fasting, 2. serum glucose level < 50 mg/dL at the time of symptom onset, and 3. relief of symptoms after administration of glucose. The patient had frequent episodes of fasting hypoglycemia (<40 mg%), anxiety, dizziness, heart palpitations, hunger, nervousness, shakiness, sweating, tremors.  Oral Glucose Tolerance Test (OGTT) revealed fasting glucose 37, glycemia after 1 h was 38,2, after 2 h – 42,2, after 3 h – 45,6 and after 4 h – 42,2. C-peptide level, measured by chemiluminescence immunoassay on “TOSOH AIA-900” revealed fasting C-peptide 0,78 (normal value 1,1-3,3 ng/ml), after 1 h – 0,68 and after 2 h – 0,71. MRI with IV contrasting revealed hypointensive signal locus 1,2 sm in diameter. Patient was under dynamic observation. CT angio, performed after 4 months revealed no pathology in the pancreas. Thus, C-peptide level excluded hyperinsulinism and CT angio excluded insulinoma. The diagnosis of non insulinoma pancreatogenic hypoglycemia was made and patient was forwarded to endocrinologists for further conservative treatment. Presented case is interesting because of rarity.