A 78-year-old male is brought to the Emergency Department and has a witnessed seizure in the resuscitation room.His blood glucose is recorded as 1.0 mmol/l. He does not have diabetes, and has no other significant past medical history.He is given 50 ml of 50% dextrose and he slowly recovers over the next one hour. A serum cortisol concentration later returns as 800 nmol/l (120-600). What has this pt prestented with, what can cause this presentation, how would you investigate this patient?
- This is a case of spontaneous hypoglycaemia, which could be caused by:
- Insulinoma
- Insulin\sulfonylurea overdose
- Drugs\alcohol
- Sepsis
In this case most likely to be an insulinoma, investigate with 72 hour fast and should another episode occur take bloods within 30mins to look for insulin+c-peptide.
The elevated cortisol is normal considering hes having a hypo and under 'stress' conditions.
