Endocrinology - Hypoglycaemia Flashcards
1
Q
What a is Whipple’s triad?
A
- Low plasma glucose =<3mM
- Symptoms consistent with hypoglycaemia
- Relief of symptoms with glucose administration
2
Q
EXPLAIN - causes of hypoglycaemia
A
- Usually will be insulin of sulfonylurea rx in known diabetic
- Exogenous drugs
- Pituitary insufficiency
- Liver failure
- Addison’s disease
- Islet cell tumours (insulinomas)
- Immune: Hodgkin’s
- Non-pancreatic neoplasms: eg fibrosarcomas
3
Q
What Ix should you do in pt with hypoglycaemia
A
- 72h fast with monitoring
- Check glucose, insulin, c peptide and ketone levels
4
Q
Outline 3 categories of diagnosis for hypoglycaemia
A
- Hyperinsulinaemic hypoglycaemia
- Hypoinsulinaemic hypoglycaemia
- Hypoinsulinaemic + high ketones
5
Q
Hyperinsulinaemic hypoglycaemia: causes
A
Drugs
- If high C peptide - sulfonylurea
- If normal C peptide - insulin
Insulinoma
6
Q
Hypoinsulinaemic hypoglycaemia: causes
A
- Non pancreatic neoplasms
- insulin receptor antibodies (eg Hodgkins)
7
Q
Hypoinsulinaemic + high ketones: causes
A
- Alcohol binge with no food
- pituitary insufficiency
- Addison’s disease
8
Q
What is an insulinoma? What is the presentation?
A
- Pathology: 95% are benign B-cell tumours (usually associated with MEN1)
- Presentation: fasting/exercised induced hypoglycaemia
9
Q
Insulinoma: Ix and Rx
A
Ix
- Bloods with show raised insulin levels and low blood glucose
- If exogenous insulin given: C peptide levels remain high
- MRI/US pancreas
Rx
-Excision
