7419 Navigating The Diagnostic Maze Of Pseudohypoglycemia In A Young Adult Male With Severe Hypertriglyceridemia: A Novel Case Report

Abstract Disclosure: C. Muojieje: None. M. Hotiana: None. Objective: This case report aims to shed light on the challenges of diagnosing and managing pseudohypoglycemia, particularly in the absence of Whipple's triad, and to explore its rare association with severe hypertriglyceridemia. Methods and Results: We present a 26-year-old Caucasian male with a history of depression, anxiety, and recently diagnosed hyperlipidaemia who presented to Cabell Huntington Hospital with intermittent chest pain and multiple episodes of syncope. Laboratory findings revealed low sodium (128 mmol/L) and significant discrepancies in blood glucose levels (52 mg/dL in laboratory tests vs. 93 mg/dL in point-of-care tests). The managing team initiated an evaluation for hypoglycaemia based on the low serum glucose values by ordering c-peptide, insulin and pro-insulin (normal findings). Endocrinology was consulted for further management of pseudo hypoglycaemia. Consultation led to further investigations, revealing severely elevated triglycerides (2,568 mg/dL), cholesterol (478 mg/dL), low HDL (26 mg/dL), and very low-density VLDL (514 mg/dL). The stat glucose test showed a level of 103 mg/dL, while the routine glucose test on the same sample was less than 10 mg/dL, and the point-of- care glucose test was 90 mg/dL. An A1c test returned normal at 4.9%, and the patient had no history of diabetes or insulin use. Conclusion: This case highlights the complexities in diagnosing pseudohypoglycemia, a condition that can present with falsely low glucose readings in the absence of clinical hypoglycemia symptoms. The significant hypertriglyceridemia observed in this patient suggests a potential novel association. The findings emphasize the need for comprehensive evaluation in cases of discordant glucose readings and suggest a potential new frontier in understanding and managing pseudohypoglycemia. Physicians should be aware of rare instances of in vitro glycolysis leading to pseudohypoglycemia and consider lipid profiles in their diagnostic process. Presentation: 6/3/2024