Hyperinsulinism (Hypoglycemic Disease)

A disease characterized by attacks of hypoglycemia caused by an absolute or relative increase in insulin levels.

Etiology, pathogenesis. Tumors of the islets of Langerhans (insulinomas), diffuse hyperplasia of β-cells of the pancreas, diseases of the central nervous system, liver, extrapancreatic tumors that secrete insulin-like substances, tumors (often of connective tissue origin) that intensively absorb glucose, insufficient production of contrainsular hormones, etc. play a role.

Hypoglycemia leads to disruption of the functional state of the central nervous system and increased activity of the sympathoadrenal system.

Symptoms, course. The disease occurs at the age of 26-55 years, most often women.

Attacks of hypoglycemia usually occur in the morning on an empty stomach, after prolonged fasting; and with functional hyperinsulinism - after taking carbohydrates. Physical activity and mental experiences can be provoking moments. In women, attacks may initially recur only in the premenstrual period.

The onset of the attack is characterized by a feeling of hunger, sweating, weakness, trembling of the limbs, tachycardia, a feeling of fear, pallor, diplopia, paresthesia, mental agitation, unmotivated actions, disorientation, dysarthria; subsequently, loss of consciousness, clinical and tonic convulsions occur, sometimes resembling an epileptic seizure, coma with hypothermia and hyporeflexia. Sometimes attacks begin with a sudden loss of consciousness. In the interictal period, symptoms appear due to damage to the central nervous system: memory loss, emotional instability, indifference to the environment, loss of professional skills, sensory disturbances, paresthesia, symptoms of pyramidal insufficiency, pathological reflexes.

Due to the need to eat frequently, patients are overweight. For diagnosis, blood sugar levels, immunoreactive insulin and C-peptide are determined (on an empty stomach and against the background of a three-day fasting test). For topical diagnosis, angiography of the pancreas, ultrasound, computed tomography, and retrograde pancreaticoduodenography are used.

Treatment of insulinoma and tumors of other organs that cause the development of hypoglycemic conditions is surgical. With functional hyperinsulinism, split meals with carbohydrate restriction are prescribed. Attacks of hypoglycemia are stopped by intravenous administration of 40-60 ml of 40% glucose solution.