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Hyperinsulinemic-euglycemic Clamps in Conscious, Unrestrained Mice

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Published on: November 16, 2011

Insulinoma masquerading as factitious hypoglycemia

J W Baddley¹, D Daberkow, C W Hilton

¹Department of Medicine, Louisiana State University Medical Center, New Orleans 70112, USA.

Southern Medical Journal

|November 21, 1998

Summary

A woman experienced spells of vision problems, fatigue, and dizziness due to low blood sugar. Further tests revealed multiple insulinomas, a rare cause of hypoglycemia, not factitious drug use.

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Area of Science:

Endocrinology
Oncology
Surgical Pathology

Background:

Hypoglycemia can present with non-specific symptoms like diplopia, fatigue, and dizziness.
Factitious hypoglycemia is a potential diagnosis, often suggested by a positive sulfonylurea screen.

Observation:

A 36-year-old woman presented with spells of diplopia, fatigue, and dizziness.
Fasting laboratory results showed hypoglycemia (glucose 40 mg/dL), elevated insulin (15 microU/mL), and C-peptide (2.5 ng/mL).
An initial sulfonylurea screen was positive for tolbutamide.

Findings:

Despite the positive sulfonylurea screen, further investigation revealed multiple pancreatic masses.
Surgical confirmation established the diagnosis of multiple insulinomas as the cause of endogenous hyperinsulinism.
This case highlights the importance of comprehensive workup beyond initial screening tests.

Implications:

Distinguishing between factitious and endogenous hypoglycemia is critical for appropriate management.
Multiple insulinomas, though rare, must be considered in cases of unexplained hyperinsulinemic hypoglycemia.
Surgical intervention is key for diagnosing and treating insulinomas.