HYPOGLYCEMIA IN NON-DIABETIC PATIENTS

Öz

Glucose is the main substance used by the brain, and as such, multiple regulatory mechanisms exist to maintain glucose concentrations. The main regulatory mechanisms are cessation of insulin secretion the stimulation of glucagon, cortisol and growth hormone secretion. When these regulatory mechanisms fail or are defective, hypoglycemia occurs. Hypoglycemia is a rare syndrome but can cause significant morbidity, excluding patients on diabetes treatment. Spontaneous hypoglycemia has difficulties in diagnosis and treatment. Therefore, a complete evaluation of the patient's clinical, laboratory and imaging studies is required. The symptoms of hypoglycemia are nonspecific and therefore it is important to confirm hypoglycemia by identifying the presence of the Whipple triad before starting an evaluation for hypoglycemia. The Whipple triad consists of symptoms consistent with hypoglycemia, a plasma glucose level of less than 55 mg/dl, and a resolution of symptoms after raising the plasma glucose level. Evaluation of hypoglycemia should be made as soon as symptoms occur spontaneously. If this is not possible, hypoglycemia is tried to be revealed with a 72-hour prolonged fasting test. If post-prandial hypoglycemiais suspected, the mixed-meal test can also be applied. Causes of endogenous hyperinsulinemic hypoglycemia include insulinoma, post-bariatric hypoglycemia, and non-insulinoma pancreatic hypoglycemia syndrome. Diagnostic imaging studies should also be performed in patients with endogenous hyperinsulinemia. Autoimmune hypoglycemia syndrome is clinically andbiochemically similar to insulinoma, but is associated with high levels of insulin antibodies and plasma insulin. Other important causes of hypoglycemia include; drugs, non-islet cell tumors,hormonal deficiencies, critical illness, and factorial hypoglycemia. In order to prevent hypoglycemia attacks, diagnostic studies should be performed to determine the etiology. Findingthe underlying cause of hypoglycemia also shows us the mechanism and enables the selection of the appropriate treatment. In this review, we provide an overview of the pathogenesis and management of hypoglycemia in non-diabetic patients.

Anahtar Kelimeler

• Hypoglycemia
• Hyperinsulinism
• Insulinoma

DİYABETİK OLMAYAN HASTALARDA HİPOGLİSEMİ

Öz

Glukoz, beyin tarafından kullanılan ana maddedir ve bu nedenle, glikoz konsantrasyonlarını korumak için çok sayıda düzenleyici mekanizma mevcuttur. Temel düzenleyici mekanizmalar insülin salınımının kesilmesi, glukagon sekresyonu, kortizol ve büyüme hormonu salınımıdır. Bu düzenleyici mekanizmalar başarısız veya kusurlu olduğunda, hipoglisemi ortaya çıkar. Diyabet tedavisi alan hastalar hariç tutulursa, hipoglisemi nadir bir sendromdur ancak önemli morbitidilere neden olabilir. Spontan hipoglisemilerde tanı ve tedavide zorluklar yaşanmaktadır. Bu nedenle hastanın klinik, laboratuvar ve görüntülemelerinin incelendiği tam bir değerlendirme gerekir. Hipogliseminin semptomları spesifik değildir ve bu nedenle, hipoglisemi için bir değerlendirmeye başlamadan önce Whipple triadının varlığını belirleyerek hipoglisemiyi doğrulamak önemlidir. Whipple triadı hipoglisemi ile tutarlı semptomlar, plazma glikoz seviyesinin 55 mg / dl'den düşük olması ve semptomların plazma glikoz seviyesinin yükseltilmesi sonrasında düzelmesi bileşenlerinden oluşur. Hipoglisemi değerlendirmesi semptomların kendiliğinden ortaya çıktığı anda yapılmalıdır. Bu mümkün değilse, 72 saat uzamış açlık testi ile hipoglisemi ortaya çıkarılmaya çalışılır. Post prandiyal hipoglisemiden kuşkulanıldığında ise karışık yemek testi (mixed-meal test) de uygulanabilir. Endojen hiperinsülinemik hipogliseminin nedenleri arasında insülinoma, post-bariatrik hipoglisemi ve non-insülinoma pankreatik hipoglisemi sendromu bulunur. Endojen hiperinsülinemi tespit edilen hastalarda tanısal görüntüleme çalışmlaları da yapmak gerekir. Otoimmün hipoglisemi sendromu klinik ve biyokimyasal olarak insülinomaya benzer, ancak yüksek seviyelerde insülin antikorları ve plazma insülini ile ilişkilidir. Hipogliseminin diğer önemli nedenleri arasında; ilaçlar, adacık hücreli dışı tümörler, hormonal eksiklikler, kritik hastalıklar ve faktisiyöz hipoglisemi bulunur. Hipoglisemi ataklarının önlenmesi için etiyolojiyi belirleyecek tanısal çalışmalar yapılmalıdır. Hipogliseminin altında yatan nedeni bulmak bize mekanizmayı da gösterir ve uygun tedavinin seçilmesini sağlar. Bu derlemede diyabetik olmayan hastalarda hipogliseminin patogenezi ve yönetimine genel bir bakış sunuyoruz.

Anahtar Kelimeler

• Hipoglisemi
• Hiperinsülinizm
• İnsulinoma.

Kaynakça

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