Endocrine Abstracts

Introduction: Diagnosis of hypoglycemia in non-diabetics is challenging in most of the cases. Appropriate diagnosis is possible only after taking proper history and performing appropriate laboratory investigation in appropriate time. The purpose of this study is to find the spectrum of etiology of hypoglycemia in non-diabetics in a tertiary hospital in a developing world with limited resources. This may help physicians working in similar situations.

Materials and methods: All patients admitted since June 2014 to June 2017 in the Tribhuvan University teaching hospital, Kathmandu for the evaluation of hypoglycemia were included in the study. Patients with diabetes and related hypoglycemia, gastric and intestinal/bowel surgeries, sepsis, starvation, cardiac, renal and hepatic failure in whom the cause of hypoglycemia was obvious were excluded from the study. In remaining twenty-one cases proper history was taken, and appropriate laboratory investigation was done. Two days of strict observation along with 72 h fasting and critical blood sampling for serum insulin and c- peptide was done.

Results: In twenty-one nondiabetic hypoglycemic patients, twelve were female and nine were male. The cause of hypoglycemia was presence of insulin autoantibody in five cases, adrenal insufficiency in five cases, reactive hypoglycemia in four cases, insulinoma in four cases, drug induced (excluding OHAs) in two cases and non-islet cell tumor hypoglycemia (Doege-Potter Syndrome) in one case. Six patients had autoimmune disease (Grave’s disease in four cases, SLE in one case and RA in one case). Five cases were insulin auto antibody positive (except one patient with RA). Four out of five cases of adrenal insufficiency were due to secondary adrenal insufficiency. Among these four cases, three were female with Sheehan’s syndrome. All four patients with reactive hypoglycemia were male and all of them presented to hospital for their concern about possibility of road traffic accident. Three out of four cases of insulinoma were male while one was female who also had associated primary hyperparathyroidism and later diagnosed as MEN 1 syndrome. In patients with drug induced hypoglycemia one was female diagnosed with RA who was taking hydroxychloroquine while another was a male taking ciprofloxacin for chronic pyelonephritis.

Conclusion: Insulin autoantibody related followed by adrenal insufficiency secondary to Sheehan’s syndrome remains the commonest cause of hypoglycemia in non-diabetics in female while reactive hypoglycemia is the commonest cause in male.