Endogenous hyperinsulinism

Endogenous insulin excess as a cause of hypoglycemia was described soon after the epic discovery of insulin in 1921. Rosco Graham removed an insulinoma and cured a patient's hypoglycemia in 1929. Adenomatosis of the islet cells as a cause of hypoglycemia was described in 1944 by Frantz, who advocated subtotal pancreatectomy for this disorder. Whipple's triad of 1. symptoms precipitated by fasting with 2. associated blood sugars of 50 mg.% or less and 3. relief of symptoms by glucose administration, is the classic description of the symptom complex of hyperinsulinism. Currently the opportunity for accurate diagnosis of hyperinsulinism has been enhanced by the availability of serum insulin radioimmunoassay (IRI). Nonetheless, delay in diagnosis with potentially tragic consequences is still common and this prompted a review of the clinical material at St. Luke's Hospital. Nine cases of organic hyperinsulinism were diagnosed between 1965 abd 1979 and form the basis of this report.