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Endocrine > 183. Hypoglycemic Disorders > Flashcards

183. Hypoglycemic Disorders Flashcards

1
Q

___ insulin is only cleared by the kidneys

A

Exogenous

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2
Q

Reduced clearance of exogenous insulin

Reduced mobilization of gluconeogenesis precursors

A

Renal failure

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3
Q

In non-beta cell tumors hypoglycemia can occur due to overproduction of __ which can then act on insulin receptors causing insulin-like activity

  • hepatomas
  • adrenocortical carcinomas
  • carcinoids

Treat with steroids or growth hormone

A

IGF-II

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4
Q

Inhibits insulin secretion

- used to treat insulinomas

A

Diazoxide

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5
Q

3 things that maintain plasma glucose levels between meals and during fasting

A
  1. Endogenous glucose production
  2. Hepatic glycogenolysis
  3. Hepatic and regal gluconeogenesis
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6
Q

Should be considered in any pt with episodes of confusion, an altered level of consciousness, or a seizure

A

Hypoglycemia

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7
Q 
ACE-Is 
ARBs 
Beta-blockers 
Quinolones 
Indomethacin 
Quinine 
Sulfonamides
A

Drugs that can cause hypoglycemia

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8
Q

Defense against prolonged hypoglycemia (2 hormones)

A

Increase cortisol and GH

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9
Q

Defective glucose counter-regulation, compromising physiologic defense

Reversible disorder

  • insulin levels do not decrease
  • glucagon levels do not increase
  • epinephrine increase is blunted towards lower BG concentrations

No adrenergic or cholinergic symptoms that make pts realize they need food

Caused by aggressive glycemic therapy for DM

Reversable with avoidance of hypoglycemia

A

Hypoglycemia associated autonomic failure

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10
Q

Sweating
Hunger
Paresthesias

A

Cholinergic symptoms of hypoglycemia

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11
Q

Primary beta-cell disorder
- functional with beta-cell hypertrophy or hyperplasia

90% are benign
- most occur in tail of pancreas

Can be sporadic or genetically inherited (MEN1)

  • 30yo when w/ MEN1
  • 50yo when sporadic

Tumoral production causes lack of negative feedback for insulin secretion continues at all times causing hypoglycemia

A

Insulinoma

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12
Q

Often seen in patients with chronic uncontrolled diabetes

Typical symptoms of hypoglycemia with a measured BG > 70 but approaching that level

A

Pseudo-hypoglycemia

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13
Q

Beta-cell secretagogue

High c-peptide levels after ingestion during hypoglycemia

A

Sulfonylurea

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14
Q

When do you measure hormones in someone with hypoglycemia if you’re suspicious for an insulinoma?

A

During hypoglycemia states

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15
Q

Used to treat hypoglycemia for unresectable tumors

- somatostatin analogue

A

Octreotide

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16
Q
  1. Symptoms consistent with hypoglycemia
  2. A low plasma glucose concentration measured with a precise method (blood draw)
  3. Relief of those symptoms after the plasma glucose level is raised
A

Whipple’s triad

17
Q

Loss of body fat stores

Depletion of gluconeogenesis precursors

Increased glucose utilization

A

Starvation

18
Q

Exercise can increase __ utilization causing insulin-independent hypoglycemia

19
Q

Insulin decreases around BG of 80-85

A

First defense against hypoglycemia

20
Q

Can’t store glycogen anymore or clear endogenous insulin

Fasting hypoglycemia is seen

A

Hepatic failure

21
Q

Usually present with post-prandial hypoglycemia

Endogenous hyperinsulinism

A

Post-gastric bypass hypoglycemia

22
Q

Glucagon levels increase around BG of 65-70

A

Second defense against hypoglycemia

23
Q

Palpitations
Tremor
Anxiety

A

Andrenergic symptoms of hypoglycemia

24
Q

Which hormone deficiency is more likely to cause hypoglycemia in children?

A

Growth hormone deficiency

25
Q

Epinephrine levels increase around BG of 65-70

A

Third defense against hypoglycemia

26
Q

Glucose is the obligate metabolic fuel for the __

27
Q

Inaccurate readings of BG can be enhanced by: (4 things)

A

Leukocytosis
Erythrocytosis
Thrombocytosis
Delayed separation (pseudohypoglycemia)

28
Q

6-10% of people with __ die as a result of hypoglycemia

29
Q

Glycogen depletion is seen in this primary adrenal insufficiency

A

Addison’s disease

30
Q

Also causes hypoglycemia although the mechanism is unclear

A

Cardiac failure

31
Q

In ill patients, increased glucose utilization by cytokines in macrophage-rich tissue

Decreased glucose production

32
Q

Exaggerated levels of __ are found in response to meals in individuals who recently underwent gastric bypass causing post-prandial hypoglycemia

Treat with low glycemic index foods

33
Q

Hormone deficiency with impaired gluconeogenesis and low levels of gluconeogenic precursors

A

Cortisol deficiency

34
Q

Blocks gluconeogenesis but not glycogenolysis
- hypoglycemia occurs after a several day binge with very little food ingestion and glycogen depletion

Contributes to hypoglycemia for patients on insulin bc gluconeogenesis becomes predominant route of glucose production during prolonged hypoglycemia

Endocrine (26 decks)

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