Clinical significance of hypoglycemia, with presentation of cases

master's thesis

• Title (croatian): Klinički značaj hipoglikemije, s prikazom slučajeva
• Author: Staffan Per Gustaf Johnsson
• Mentor: Ivana Pavlić-Renar (mentor)
• Committee member: Ivana Pavlić-Renar (predsjednik povjerenstva)
• Committee member: Darko Kaštelan (član povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2017-07-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

The clinical significance of hypoglycemia is important to understand as there are many etiologies and, if not treated, can have devastating consequences, such as coma or even death. Etiologies range from tumors to iatrogenic hypoglycemia, from postprandial hypoglycemia to renal failure. The majority of those who are at risk of getting hypoglycemia are patients treated with insulin or insulin secretion stimulating drugs. However, there are many other causes of hypoglycemia, but the most of them are rare. To diagnose hypoglycemia, Whipple’s triad must be met: symptoms of hypoglycemia, low blood glucose measured at the time of symptoms and relief of symptoms after the blood glucose level is corrected. The cases discussed in this thesis will explore a more common cause of hypoglycemia, sulfonylurea induced (iatrogenic), and a rare cause, insulinoma. In the first case, an elderly patient with renal insufficiency developed hypoglycemia due to the use of glimepiride, a second generation sulfonylurea. By simply taking the medicine out of her regimen the patient did not experience any further hypoglycemic attacks. In the second case, a middle aged woman presented with episodes of lightheadedness and tremors for years with occasional loss of consciousness and weight. These attacks happened at any time, even during fasting, and were relieved by a sweet drink. These signs and symptoms lead to the suspicion of an insulinoma, which was later confirmed with laboratory testing and diagnostic imaging. The tumor was resected, and since, the patient has not had any further hypoglycemic attacks.

Abstract (croatian)

Kako neki oblici hipoglikemije mogu imati ozbiljne posljedice i neliječene mogu biti smrtonosne, važno je razlučiti etiologiju hipoglikemije. Ona je vrlo različita: od tumora do jatrogene hipoglikemije, od postprandijalne hipoglikemije do zatajenja bubrega. Većina pacijenata, koji su u riziku od hipoglikemija, su osobe sa šećernom bolešću liječenom inzulinom ili lijekovima koji stimuliraju sekreciju inzulina. Međutim, brojni su drugi uzroci pojedinačno rijetki. Glavni kriterij za dijagnozu hipoglikemije je Whippleova trijada: simptomi, izmjerena niska glikemija u vrijeme simptoma i nestanak simptoma kada se glikemija korigira. U ovom radu će se prikazati jedan primjer uobičajenog slučaja hipoglikemije: jatrogene, uzrokovane sulfonilurejom - i jedan rijedak uzrok - inzulinom. U prvom prikazu, starija žena s renalnom insuficijencijom razvija hipoglikemiju uz glimepirid, sulfonilureju druge generacije. Nakon izostavljanja lijeka iz terapije pacijentica nije imala više napada hipoglikemije. U drugom prikazu sredovječna žena je godinama imala epizode omaglica i tremora s povremenim nesvjesticama i porastom težine. Napadi su se događali u bilo koje vrijeme, pa i natašte, i ublažavani su slatkim napitcima. Ovi znakovi i simptomi su pobudili sumnju na inzulinom, što je dokazano laboratorijskim i slikovnim tehnikama. Tumor je nađen u repu pankreasa i nakon resekcije istog više nije bilo hipoglikemijskih napada.

• Keywords: hypoglycemia; insulinoma; sulfonylurea; fasting test; calcium stimulation
• Keywords (croatian): hipoglikemija; inzulinom; sulfonilureja; test gladi; stimulacija kalcijem
• Language: english
• URN:NBN: urn:nbn:hr:105:339397
• Study programme: Title: Medicine (in English language); Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2018-04-18 11:25:35