Endocrine Abstracts

Hypoglycaemia, a life threatening complication, occurs as part of a wide variety of disease processes. Though a common side effect of diabetes medications, it can be secondary to other factors including, endocrine and, metabolic disorders, severe sepsis, rare malignancies and non-diabetic medications. We present a case series of 3 non-diabetic patients who presented to Princess of Wales, Bridgend with Hypoglycaemic Episodes (HE):

1. 23 year old student nurse with episodes of sweating and tremors coinciding with HE (2.2 to 3.5 mmol/l) throughout the day and history of gaining 15Kg weight. Her sister had Type 1 diabetes. Thyroid function test, Short Synacthen test and anti-GAD antibody were normal. We conducted a 72 hour fast during which blood glucose did not drop <3.1mmol/l, along with appropriate suppression of Insulin (<3.0pmol/l) and C-peptide (299pmol/l). Sulphonylurea screen was negative. Dietary modifications resolved fasting HE but postprandial HE persisted. With a clinical diagnosis of postprandial reactive hypoglycaemia, trial of Acarbose along with dietician input was recommended. Due to patient’s reluctance, symptoms persist. She is now seeking a 4th opinion!

2. 85 year old woman with heart failure presented with severe sepsis and HE of 1.4mmol/l which persisted even after successful treatment of sepsis. Medication review led to Sacubitril as rare cause for HE, proven on resolution of HE after withdrawing Sacubitril.

3. 27 year old man without co-morbidities presenting with neuroglycopaenic symptoms and HE, with family history of maternal neuroendocrine tumour. A positive 72 hour fast demonstrated hypoglycemia of 1.8mmol/l, and inappropriately raised C-peptides (718 pmol/l) and Insulin (25.7pmol/l) levels. MRI pancreas demonstrated 1cm lesion in tail. MRI pituitary was normal in spite of elevated prolactin of 687mIU/l. Patient started on Diazoxide while awaiting pancreatic surgery. Genetic testing is negative for MEN 1.

Hypoglycaemia can affect people without diabetes and this beehoves us to extract history carefully, examine and review the medications keeping rare causes in mind as well.