Hypoglycemia syndrome: features of differential diagnostics

Diagnosis and differential diagnosis of hypoglycemia syndrome may present some difficulties for general practitioners. Clinical manifestations of hypoglycemia are weakness, tachycardia, tremor, sweating, impaired consciousness up to coma. Symptoms of hypoglycemic conditions at the beginning of their development are often nonspecific, the severity of their manifestations is lost with frequent recurrence. It is important to note that hypoglycemia is a life-threatening condition requiring treatment. Hypoglycemia can be caused by taking hypoglycemic drugs, exacerbation of chronic adrenal insufficiency, or increased secretion of insulin by a tumor – insulinoma. Iatrogenic hypoglycemia in patients with diabetes mellitus is recognized by patients quite quickly, since patients regularly monitor glycemic levels. Hypoglycemia in adrenal insufficiency usually occurs in the early morning hours. In insulinoma, hypoglycemia may develop at any time of the day, since it is associated with spontaneous or provoked secretion of large amounts of insulin by the tumor. The size of the insulinoma may be small, which complicates confirmation of the diagnosis by visualization. Also, insulinoma may occur as one of the manifestations of the syndrome of multiple endocrine neoplasia – in this case, it is necessary to assess the function of the parathyroid glands and pituitary gland. The article presents a clinical case of multiple recurrent insulinoma in a young patient. This clinical observation is of particular interest, since it presents the process of primary diagnostics of insulinoma, as well as postoperative dynamic observation of the patient, during which a relapse of the neoplasm was detected. As part of the preoperative preparation, therapy with short-acting somatostatin analogues was prescribed, after which repeated surgical treatment was performed.