Hipoglicemia hiperinsulínica: a propósito de un caso

El diagnostico de hipoglicemia se confirma con la triada de Whipple: sintomas de hipoglicemia, concentracion plasmatica baja de glucosa, y desaparicion de los sintomas con la elevacion de los niveles de glucosa. Se presenta el caso de una paciente de 26 anos de edad, que consulto a nuestro servicio en julio de 2013 por episodios intermitentes que se iniciaron en octubre del ano precedente, consistentes en vision borrosa, cambios conductuales y discurso incoherente, sin relacion con la ingesta o el ayuno, que aumentaron en frecuencia los meses previos a la consulta y llegaron a asociarse a perdida de conocimiento y relajacion de esfinteres, requiriendo asistencia medica prehospitalaria. Ocasionalmente hubo registros bajos de glicemia capilar, y hubo mejoria sintomatologica con la administracion de glucosa e.v. Durante una prueba de ayuno presento una hipoglicemia sintomatica con glicemia 48 mg/dl, insulinemia 21,1 µU/ml, peptido C 2.257 ng/ml. La ecografia de abdomen identifico una imagen solida en la union de cuerpo y cola del pancreas. La lesion fue enucleada quirurgicamente, y la anatomia patologica confirmo su origen neuroendocrino (AU). The diagnosis of hypoglycemia is confirmed by Whipple’s triad: symptoms of hypoglycemia, low plasma glucose concentrations, and disappearance of symptoms after glucose administration. The case of a 26-year-old woman is presented. She consulted our Service in July 2013 due to intermittent episodes that had begun in October of the preceding year, characterized by blurred vision, slurred speech, and behavioral changes, unrelated to food ingestion. They increased in frequency, and were associated eventually with loss of consciousness and loss of sphincters control, requiring medical care. Occasionally, low capillary glucose levels were recorded, and there was improvement in symptoms with i.v. glucose administration ev.During a fasting test she had symptomatic hypoglycemia with serum glucose of 48 mg/dl, serum insulin 21.1 µU/ml, and serum C-peptide 2.257 ng/ml. Abdominal ultrasound identified a rounded image in the union of the body and tail of the pancreas; this was confirmed by MRI. The lesion was surgically enucleated, and the pathology report confirmed its neuroendocrine origin (AU).