SHM Converge Scientific Abstract ePoster Gallery-Much More Complex Case Than Your Usual Non-Insulinoma Pancreatogenous Hypoglycemia

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This case report describes a 40-year-old woman with recurrent symptomatic hypoglycemia ultimately felt to be due to non-insulinoma pancreatogenous hypoglycemia (NIPH), a rare cause of endogenous hyperinsulinemic hypoglycemia. NIPH is usually associated with postprandial hypoglycemia, negative fasting studies, negative imaging for insulinoma, and diffuse insulin secretion on selective arterial calcium stimulation testing. It is more commonly reported after bariatric surgery, but this patient’s presentation was unusual because her hypoglycemic episodes began years before Roux-en-Y gastric bypass and she was also suspected to have factitious hypoglycemia because she had access to insulin as a healthcare worker.<br /><br />She presented after loss of consciousness with glucose as low as 33 mg/dL and continued to have refractory hypoglycemia despite dextrose infusions. Labs showed inappropriately elevated insulin with low, but unsuppressed, C-peptide, negative insulin antibodies, negative sulfonylurea screen, and normal cortisol testing. Extensive imaging, including CT and MRI, did not localize a pancreatic tumor, though one MRI later showed a small indeterminate tail lesion. A selective arterial calcium stimulation test demonstrated diffusely increased insulin secretion without localization, supporting NIPH. A Dotatate scan was inconclusive.<br /><br />During hospitalization, she required prolonged D10 infusion and escalating octreotide doses, later transitioned to lanreotide and acarbose. Her course was also complicated by Dumping Syndrome. She improved enough for discharge with endocrine follow-up.<br /><br />The authors emphasize that NIPH should remain in the differential for persistent unexplained hypoglycemia, even when factitious hypoglycemia seems plausible. The case highlights the need for careful, nonjudgmental evaluation and multidisciplinary workup in complex hypoglycemia.

Asset Subtitle

Ji Won Kim

Meta Tag

Author List Ji Won Kim, Natalie Anumolu, Pinky Jha, Reshmi Joseph

Category Clinical Vignettes

Concept Non-insulinoma Pancreatogenous Hypoglycemia

Concept Hyperinsulinemic Hypoglycemia

Concept Islet Cell Hyperplasia

Concept Postprandial Hypoglycemia

Concept Insulinoma

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Ji Won Kim

Track Adult

Keywords

non-insulinoma pancreatogenous hypoglycemia

NIPH

recurrent hypoglycemia

endogenous hyperinsulinemic hypoglycemia

selective arterial calcium stimulation test

postprandial hypoglycemia

factitious hypoglycemia

Roux-en-Y gastric bypass

octreotide

lanreotide

Non-insulinoma Pancreatogenous Hypoglycemia

Hyperinsulinemic Hypoglycemia

Islet Cell Hyperplasia

Postprandial Hypoglycemia

Insulinoma