Hypoglycemia Interpretation Flashcards
What condition is characterized by excessive insulin levels?
Hyperinsulinemia
This can be due to insulinoma, exogenous insulin, or sulfonylurea use.
What is the plasma insulin concentration indicative of insulin excess?
≥23.0 plU/mL (≥20.8 pmol/L) with plasma glucose <55 mg/dL (<3.1 mmol/L)
This indicates hyperinsulinemia.
What is the significance of measuring C-Peptide levels in diagnosing insulinoma?
C-Peptide levels help differentiate between endogenous and exogenous insulin sources.
Low C-Peptide levels suggest exogenous insulin.
What are the C-Peptide level thresholds for diagnosing hyperinsulinemia?
≥0.6 ng/mL (≥0.20 nmol/L) indicates insulin excess; <0.6 ng/mL (<0.20 nmol/L) suggests exogenous insulin.
These levels help in confirming the source of insulin.
What is the threshold for Proinsulin levels in diagnosing insulinoma?
≥44 pg/mL (≥5.0 pmol/L)
Normal or low levels are <44 pg/mL (<5 pmol/L).
What does a 3-Hydroxybutyrate level of >2.7 mmol/L indicate?
Indicates insulinoma or sulfonylurea use.
Abdominal CT can be used for localization after ruling out sulfonylurea.
What is the recommended screening for patients with suspected insulinoma?
Supervised fast and plasma insulin testing
This helps to confirm the diagnosis effectively.
What is the role of the Cosyntropin-stimulation test in diagnosing insulinoma?
No role
It’s unnecessary in the context of hypoglycemia evaluation.
What is the plasma insulin concentration indicative of sulfonylurea use?
≥23.0 ulU/mL (≥20.8 pmol/L)
This can overlap with insulinoma diagnosis.
What is the guideline regarding the measurement of IGF-2 in insulinoma diagnosis?
Measurement of IGF-2 is not required
It is unnecessary if all necessary laboratory tests for hypoglycemia are already documented.
Fill in the blank: Plasma insulin concentration indicating insulin excess is _______.
≥23.0 plU/mL (≥20.8 pmol/L) with plasma glucose <55 mg/dL (<3.1 mmol/L)
This indicates hyperinsulinemia.
True or False: Proinsulin levels below 44 pg/mL are normal.
True
Normal or low Proinsulin levels are <44 pg/mL (<5 pmol/L).
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What is the significance of suppressed B-hydroxybutyrate and increased glucose after glucagon in a patient?
Indicates a potential issue with glucose metabolism or hormone regulation
This observation can suggest an abnormal response to glucagon, possibly linked to hypoglycemia.
What levels are noted in a patient with suspected hypoglycemia related to IGF-2?
Low insulin and C-peptide levels
These findings can help differentiate between endogenous and exogenous causes of hypoglycemia.
What weight change is noted in patients with hypoglycemia related to IGF-2?
Weight loss noted
Weight loss can be a significant symptom in cases of malignancy or hormone imbalances.
What is a possible diagnosis for a patient with excess circulating IGF-2?
Possible tumor producing excess circulating IGF-2
This condition may arise from an undiagnosed malignancy.
What imaging technique is used to confirm the diagnosis of a tumor related to IGF-2?
Whole-body imaging
This is crucial for locating the tumor responsible for excess IGF-2 production.
What ratio is measured to confirm tumor secretion of IGF-2?
IGF-2 to IGF-1 ratio
A ratio greater than 3 indicates tumor secretion of IGF-2.
True or False: An IGF-2 to IGF-1 ratio of >3 indicates tumor secretion of IGF-2.
True
This finding is critical in diagnosing conditions related to IGF-2.
What condition may cause impaired glucagon response due to low glucose stores?
Adrenal Insufficiency
This condition can complicate the picture of hypoglycemia.
What is a characteristic finding in factitious insulin administration?
C-peptide usually undetectable
This finding helps to differentiate factitious causes from endogenous insulin production.
What weight change is unexpected in cases of factitious insulin administration?
Weight loss not expected
Patients typically do not lose weight in factitious insulin cases, unlike those with malignancies.
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