Differentiation of hypoglycemic states according to their heterogeneity (review and personal observation)
Abstract
The article is dedicated to the problems of differentiated diagnostics of conditions, which are accompanied by the development of hypoglycemia. In clinical practice hypoglycemic syndrome usually associated with diabetes mellitus and considered as consequences of hypoglycemic treatment but causes of this conditions can be different. In the review possible causes of low blood sugar of endocrine and non-endocrine genesis are discussed, their pathogenetic mechanisms are explained.It is emphasized that often hypoglycemic states remain undiagnosed on the background of existing severe somatic pathology, while they can be the cause of deterioration, coma, and sometimes even death of the patient. Among the causes of hypoglycemic states of non-endocrine origin, malignant tumors occupy a special place, as illustrated by the clinical case from personal experience presented in the article.Analyzing this medical history, it should be noted that not always the diagnosis, which seemed obvious at first, is confirmed after a thorough examination of the patient. In addition, the genesis of hypoglycemic seizures often cannot be established as quickly as in our clinical case, especially in oncologic pathology. It may be due to the small size of the malignancy, difficult availability of the tumor for imaging by instrumental methods and other factors. Numerous diagnostic algorithms for determining the cause of hypoglycemic states have been described in the literature, but each of the following algorithms only complements the previous one, taking into account the results of new clinical trials. The article emphasizes that strict adherence to modern guidelines for the management of patients with hypoglycemia will not only promote the timely establishment of the etiological factor of this condition and adequate treatment of the underlying disease, but also improve the quality and sometimes save the patient’s life.
Downloads
References
Man’kovskiy, B. (2007) Gipoglikemicheskiy sindrom: etiologicheskiye faktory, algoritm diagnostiki i lecheniya. Therapia. Ukrainskiy meditsinskiy vestnik. 1 (11), 26–28 [in Russian].
Korolev, V. (2011) Otsenka riska gipoglikemii v klinike vnutrennikh bolezney. Zhurnal Grodnenskogo gosudarstvennogo meditsinskogo universiteta, 2, 44–48 [in Russian].
Korolev, V., Saltanov A. (2009) Hypohlykemyya v klynyke yntensyvnoy terapyy. Ukrayinsʹkyy zhurnal ekstremalʹnoyi medytsyny imeni H. O. Mozhayeva. 10 (4), 42–47 [in Russian].
Morales, J., Schneider D. (2014) Hypoglycemia. Am J Med, 127 (Suppl 10), S17–S24. DOI: 10.1016/j.amjmed.2014.07.004
Mannucci, E., Monami, M., Mannucci, M., Chiasserini, V., Nocoletti, P., Gabbani, L., Giglioli, L., Masotti, G, Marchionni, N. (2006) Incidence and prognostic significance of hypoglycemia in hospitalized non-diabetic elderly patients. Aging Clin Exp Res. 18 (5), 446–451. DOI: 10.1007/bf03324842
Wilson, V. (2011) Non-diabetic hypoglycaemia: causes and pathophysiology. Nurs Stand. 25 (46), 35–39. DOI: 10.7748/ns.25.46.35.s49
Alkén, J., Petriczko, E., Marcus, C. (2008) Effect of fasting on young adults who have symptoms of hypoglycemia in the absence of frequent meals. Eur J Clin Nutr, 62, 721–726. DOI: 10.1038/sj.ejcn.1602785
Mongraw-Chaffin, M., Beavers, D. P., McClain, D. A. (2019) Hypoglycemic symptoms in the absence of diabetes: Pilot evidence of clinical hypoglycemia in young women. J Clin Transl Endocrinol, Jul 24;18, 100202. DOI: 10.1016/j.jcte.2019.100202
Kaplowitz, P., Sekizkardes, H. (2019) Clinical and laboratory characteristics and follow up of 62 cases of ketotic hypoglycemia: a retrospective study. Int J Pediatr Endocrinol, 3.
DOI: 10.1186/s13633-019-0066-9
Chaychenko, T. (2017) Postprandial'nyy gipoglikemicheskiy sindrom Zdorov’ya ditini, 12 (2.1), 273–278.
Galati, S., Rayfield E. J. (2014) Approach to the patient with postprandial hypoglycemia. Endocrine practice: official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 20 (4), 331–340. DOI: 10.4158/EP13132.RA
Doskina, Ye. (2016) Patsiyent s gipoglikemiyey na priyeme vracha obshchey praktiki. Meditsinskiy sove,. 5, 108–112. DOI: 10.21518/2079-701X-2016-05-108-112
Kumar, J. G., Abhilash, K. P., Saya, R. P., Tadipaneni, N., Bose, J. M. (2017) A retrospective study on epidemiology of hypoglycemia in Emergency Department. Indian J Endocrinol Metab, 21 (1), 119–124. DOI: 10.4103/2230-8210.195993
Desimone, M. E., Weinstock, R. S. (Updated 2017) Non-Diabetic Hypoglycemia. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK355894/
Gerich, J. E., Meyer, C., Woerle, H. J., Stumvoll, M. (2001) Renal Gluconeogenesis. Diabetes Care, 24 (2), 382–391. DOI: 10.2337/ diacare. 24.2.382
De Boer, I. H., Utzschneider, K. M. (2017) The kidney’s role in systemic metabolism - still much to learn. Nephrology Dialysis Transplantation, 32 (4), 588–590. DOI: 10.1093/ndt/gfx027
Moen, M. F., Zhan, M., Hsu, V. D., Walker, L. D., Einhorn, L. M., Seliger, S. L., Fink, J. C. (2009) Frequency of hypoglycemia and its significance in chronic kidney disease. Clin J Am Soc Nephrol. 4 (6), 1121–1127. DOI: 10.2215/CJN.00800209
Toor, A., Toor, A., Krishnamurthy, M. (2019) Critical Illness Associated Fatal Hypoglycemia in a Nondiabetic Male. Case Rep Crit Care, 4790320. DOI: 10.1155/2019/4790320
Schovanek, J., Cibickova, L., Ctvrtlik, F., Tudos, Z., Karasek, D., Iacobone, M., Frysak, Z. (2019) Hypoglycemia as a Symptom of Neoplastic Disease, with a focus on Insulin-like Growth Factors Producing Tumors. J Cancer, 10 (26), 6475–6480. DOI: 10.7150/jca.30472
Kittah, N. E., Vella, A. (2017) Management of endocrine disease: Pathogenesis and management of hypoglycemia. Eur J Endocrinol, 177 (1), 37–47. DOI: 10.1530/EJE-16-1062
De Groot, J. W., Rikhof, B., van Doorn, J., Bilo, H. J., Alleman, M. A., Honkoop, A. H., van der Graaf, W. T. (2007) Non-islet cell tumour-induced hypoglycaemia: a review of the literature including two new cases. Endocr Relat Cancer, 14 (4), 979–993. DOI: 10.1677/ERC-07-0161
Legare, T. B., Hamilton, O., Dhannoon, S., Ali, S. (2017) Non-Islet Cell Tumor Hypoglycemia: A Rare Cause of Hypoglycemia in Pulmonary Sarcomatoid Cancer. Cureus, 9 (12), e1972. DOI: 10.7759/cureus.1972
Cryer, P. E., Axelrod, L., Grossman, A. B., Heller, S. R., Montori, V. M., Seaquist, E. R., Service, F. J. (2009) Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 94 (3), 709–728. DOI: 10.1210/jc.2008-1410
Martens, P., Tits, J. (2014) Approach to the patient with spontaneous hypoglycemia. Eur J Intern Med, 25 (5), 415–421. DOI: 10.1016/j.ejim.2014.02.011
The Journal of V. N. Karazin Kharkiv National University, series Medicine has following copyright terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work’s authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal’s published version of the work, with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
