Endocrine Abstracts

JOINT2601

Nondiabetic hypoglycemia is a challenging condition for diagnosis and management. We retrospectively reviewed the records of the patients diagnosed with nondiabetic hypoglycemia who visited our center from May 2013 to November 2024. Total 36 patients were included in this study. The mean age was 48.33 ± 14.30 years (range 19- 75 years). 21(58.33%) patients were male and 15(41.67%) were female. The average weight was 70.27 ± 12.82 (range 47-100) kg and average BMI was 27.65 ± 4.84 (range18.6-37.3) kg/m². All patients had symptoms of hypoglycemia with positive Whipple’s triad. Weight gain was seen in 26(72.22%) patients.1 (2.77%) patient had a history of seizure and 3(8.33%) patients had loss of consciousness. The major cause of hypoglycemia was reactive hypoglycemia in 22 patients (61.11%) followed by hyperinsulinemic hypoglycemia in 7 patients (19.44%). Out of 7 hyperinsulinemic hypoglycemia patients, insulinoma was detected in 6 patients.1 (2.77%) patient had drug induced (carbimazole) hypoglycemia, 1(2.77%) patient had post bariatric surgery hypoglycemia and 1 (2.77%) patient had post gastrectomy (for gastric carcinoma) hypoglycemia. 2 (5.55%) patients had sarcoma-associated hypoglycemia (1 had retroperitoneal sarcoma and other Ewing sarcoma).1(2.77%) patient had purely alcohol induced hypoglycemia.1(2.77%) patient had hemodialysis induced hypoglycemia. In cases of hyperinsulinemic hypoglycemia, the average blood sugar level during hypoglycemia was 42.98 ± 11.0 mg/dl (range 29-57mg/dl), insulin level was 35.07± 53.82 mIU/l (range 5.28 - 156.2 mIU/l) and C peptide level was 4.47 ± 4.24 ng/ml(range 0.6-13.5 ng/ml). In a 72 hour fast, 2 patients had hypoglycemia within 6 hours, 2 patients within 12 hours, 1 patient within 24 hours, 1 patient within 48 hours and 1 patient within 72 hours. All reactive hypoglycemia patients were diagnosed by extended oral glucose tolerance test. Comorbidities like prediabetes were present in 10 patients, diabetes in 3 patients, hypothyroidism in 15 patients, 7 patients had chronic cardiovascular disease, 1 patient had CKD and 1 patient had OSA. Out of 6 patients with insulinoma, 5 patients had tumour located in tail of pancreas and 1 patient had in uncinate process of pancreas. The maximum size of insulinoma was 14.4 mm and the minimum was 1 mm. Enucleation was done in 4 cases of insulinoma and 1 patient underwent distal pancreatectomy. 5 insulinoma cases were cured after surgery. One case of insulinoma was lost to follow up. Out of 22 cases of reactive hypoglycemia, acarbose was used in 15 patients and the rest were managed by dietary modifications.