Keterangan
Hypoglycemia is a condition in which your blood sugar (glucose) level is lower than the standard range. Glucose is your body's main energy source. Hypoglycemia needs immediate treatment. For many people, a fasting blood sugar of 70 milligrams per deciliter (mg/dL), or 3.9 millimoles per liter (mmol/L), or below should serve as an alert for hypoglycemia. But your numbers might be different. Treatment involves quickly getting your blood sugar back to within the standard range either with a high-sugar food or drink or with medication. Long-term treatment requires identifying and treating the cause of hypoglycemia.
Ringkasan
- The presentation begins with a case of a 55-year-old man experiencing weakness, reduced appetite, and weight loss. Physical examination revealed hyperpigmentation of the tongue, oral mucosa, and palmar creases. Initial investigations showed elevated potassium and a low cortisol level, leading to suspicion of adrenal insufficiency. A short synacthen test confirmed the diagnosis of primary adrenal insufficiency, specifically Addison's disease.
- The speaker then describes the Synacthen stimulation test, highlighting the importance of checking cortisol levels in the morning. He also explains the different forms of adrenal insufficiency: primary (adrenal gland issue), secondary (pituitary issue), and tertiary (iatrogenic steroid use). Long-term steroid replacement therapy was initiated for the patient, leading to improved appetite, weight, and reduced weakness.
- The second case involves a 28-year-old woman presenting with weight loss, anxiety, and palpitations. Physical examination revealed Fine Tremor and a small diffused goiter, along with tachycardia and irregular pulse, suggesting hyperthyroidism. Different causes of hyperthyroidism, including Graves' disease and Subacute thyroiditis, are discussed. A thyroid uptake scan helps differentiate between the causes.
- The differences in radioisotope uptake patterns between Graves' disease (increased uptake) and thyroiditis (decreased uptake) are explained. Management strategies differ based on the diagnosis; thyroiditis often requires temporary beta-blockers, while Graves' disease necessitates longer-term antithyroid medications for at least 18 months. The case highlights the importance of monitoring for potential side effects of carbimazole, such as neutropenia.
- The final and main case focuses on a non-diabetic patient with recurrent hypoglycemia. The initial suspicion was directed towards insulinoma. Continuous dextrose infusion was needed to manage the low blood sugars, and lab tests confirmed elevated insulin and C-peptide levels. Contrast-enhanced CT scan was initially unrevealing, prompting an endoscopic ultrasound, which detected a mass in the tail of the pancreas.
- The mass was determined to be a functional neuroendocrine tumor through FNAC. The tumor was resected through a laparoscopic distal pancreatectomy. Afterward, the patient's blood sugar levels stabilized, and continuous dextrose infusion was no longer needed. The presentation stresses the rare nature of insulinomas and the importance of excluding other causes of hypoglycemia before suspecting this diagnosis.
- The lecture addresses hypoglycemia, emphasizing the importance of Whipple's triad (symptoms, low blood sugar, resolution with glucose). Distinctions between sympathomimetic and neuroglycopenic symptoms are highlighted. In non-diabetic patients, causes like adrenal insufficiency, autoimmune disorders, and neuroendocrine tumors must be considered.
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