Endocrine Abstracts

Introduction: Hypoglycemia in non-diabetic patients is a rare condition. Because of the non-specificity of its symptoms and the multiplicity of its causes, hypoglycemia represents often a diagnostic challenge for general practitioners. The aim of our study was to assess the clinical features of hypoglycemia and to determine its causes in non-diabetic patients.

Methods: We conducted a retrospective analysis in 49 non-diabetic patients who were admitted to our endocrinology department between 2012 and 2017 with a clinical suspicion of hypoglycemia. The diagnosis of hypoglycemia was established using Whipple’s triad. In patients with confirmed hypoglycemia, clinical and paraclinical features were analyzed.

Results: Among the 49 participants, Whipple’s triad was documented in only 40 patients. In the other patients, symptoms were secondary to cardiac arrhythmia, anxiety attack, hysteria and dizziness. The mean age of patients with confirmed hypoglycemia was 43±19.57 years [14–80 years] and the sex-ratio (F/M) was 2.14. Thirty nine percent of our patients were unemployed and 65% of patients have a diabetic family’s member. Hypoglycemia was severe in 51% of cases. Neurogenic symptoms were present in 97% of cases (sweating, palpitations and shakiness in 90%, 73% and 61% of cases, respectively). Neuroglycopenic signs were reported in 70% of cases: seizure and coma were found in 17% and 36% of cases, respectively.The mean concomitant blood glucose concentration was 0.37±0.1g/l. Etiological investigations revealed reactive hypoglycemia in 21% of cases and organic hypoglycemia in 79% of cases. Adrenal insufficiency was diagnosed in 29% of cases, factitious hypoglycemia in 24% of cases, drug induced hypoglycemia in 15%, paraneoplastic hypoglycemia secondary to gastrointestinal stromal tumor was diagnosed in one case. In three cases, the cause of hypoglycemia was unknown.

Conclusion: Although autonomic and neuroglycopenic symptoms are highly suggestive of hypoglycemia, the diagnosis of hypoglycemia should be established only in the presence of Whipple’s triad.Then, appropriate evaluation should be conducted in order to set up the underlying cause.