The diagnosis and treatment of hypoglycemia that is due to drugs, critical organ failure, or endocrine deficiency is usually straightforward. Referral of patients to an endocrinologist is warranted if they have documented fasting hypoglycemia and the diagnosis is not clear after a diagnostic fast with measurement of plasma insulin and C-peptide. Patients with endogenous hyperinsulinism should be referred to a surgeon with experience in treatment of these disorders.
Cryer PE: Glucose counterregulation: prevention and correction of hypoglycemia in humans, Am J Physiol 264:E149-155, 1993.
Daughaday WH: The pathophysiology of IGF-II hypersecretion in non-islet cell tumor hypoglycemia, Diabetes Metab Rev 3:62, 1995.
Doherty GM et al: Results of a prospective strategy to diagnose, localize, and resect insulinomas, Surgery 110:989-997, 1991.
Grunberger G et al: Factitious hypoglycemia due to surreptitious administration of insulin: diagnosis, treatment and long-term follow-up, Ann Intern Med 108:252-257, 1988.
Heerden JA et al: Occult functioning insulinomas: which localizing studies are indicated? Surgery 112: 1010-1015, 1992.
Heller SR, Cryer PE: Reduced neuroendocrine and symptomatic responses to subsequent hypoglycemia
after one episode of hypoglycemia in nondiabetic humans, Diabetes 40:223-226, 1991.
Kao PC et al. Proinsulin by immunochemiluminometric assay for the diagnosis of insulinoma, J Clin Endocrinol Metab 78:1048-1051, 1994.
Mitrakou A et al. Reversibility of unawareness of hypoglycemia in patients with insulinomas, N Engl J Med 329:834-839, 1993.
Moertel CG et al: Streptozocin-doxorubicin, streptozocin-fluorouracil, or chlorozotocin in the treatment of advanced islet-cell carcinoma, N Engl J Med 326:519-523, 1992.
Service FJ: Hypoglycemic disorders, N Engl J Med 332:1144-1152, 1995.
Service FJ et al: Functioning insulinoma: incidence, recurrence and long-term survival of patients—a 60-year study, Mayo Clin Proc 66:711-719, 1991.
Snorgaard O, Binder C: Monitoring of blood glucose concentration in subjects with hypoglycemic symptoms during everyday life, Br Med J 300:16-18, 1990.
Thomas PM et al: Mutations in the sulfonylurea receptor gene in familial persistent hyperinsulinemic hypoglycemia of infancy, Science 268:426-429, 1995.
Towler DA et al: Mechanism of awareness of hypoglycemia: perception of neurogenic (predominantly cholinergic) rather than neuroglycopenic symptoms, Diabetes 42:1791-1798, 1993.
- Differential Diagnosis
- Hypoglycemia due to Pancreatic B cell tumors
L General Considerations
L Clinical Findings
- Persistent Islet Hyperplasia
- Hypoglycemia Due to Extrapancreatic Tumors
- Postprandial Hypoglycemia (Reactive Hypoglycemia)
L Postgastrectomy Alimentary Hypoglycemia
L Functional Alimentary Hypoglycemia
L Late Hypoglycemia (Occult Diabetes)
- Alcohol-Related Hypoglycemia
L Fasting Hypoglycemia after Ethanol
L Postethanol Reactive Hypoglycemia
- Factitious Hypoglycemia
- Immunopathologic Hypoglycemia
- Drug-Induced Hypoglycemia