An unusual cause of hyperinsulinaemic hypoglycaemia syndrome

• Published in: Diabetic medicine Vol. 20; no. 9; pp. 772 - 776
• Main Authors: Manning, P. J., Espiner, E. A., Yoon, K., Drury, P. L., Holdaway, I. M., Bowers, A.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.09.2003; Blackwell
• Subjects: Biological and medical sciences; Calcium; calcium stimulation test; Diagnosis, Differential; Drug intoxications. Doping; Female; Homicide; Humans; Hyperinsulinism - chemically induced; hypoglycaemia; Hypoglycemia - chemically induced; Insulinoma - diagnosis; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Sulfonylurea Compounds - poisoning; sulphonylurea drugs; Endocrinopathy; Human; Hyperinsulinemia; Calcium; hypoglycaemia; Insulinoma; Hypoglycemia; Murder; sulphonylurea drugs; Differential diagnostic; calcium stimulation test; homicide; Secretory tumor; Case study; Hypoglycemic agent; False negative; Sulfonylureas; Female; Poisoning; Benign neoplasm; Endocrine pancreatic diseases; Pancreatic disease
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1046/j.1464-5491.2003.01033.x

Endogenous hyperinsulinism as a cause for hypoglycaemia can be attributed to a number of different causes including insulinoma, sulphonylurea drugs and the newly described disorder non‐insulinoma pancreatogenous hypoglycaemia (NIPH). The calcium stimulation test is increasingly used as a method for not only localizing insulinoma but also for distinguishing the above entities. We describe a case in which felonious sulphonylurea administration was used to mimic either an insulinoma or NIPH. Importantly, this case demonstrates that, contrary to previous reports, the insulin response to calcium stimulation in such cases may be uniformly positive and should alert the physician to possible surreptitious sulphonylurea ingestion.