CLASSIFICATION OF HYPOGLYCEMIC DISORDERS - 08/09/11
Résumé |
Although low concentrations of blood glucose were recognized as a concomitant of some disease states in the nineteenth century,100 it was not until insulin became available for the treatment of diabetes mellitus in the early 1920s that symptoms similar to those arising from overtreatment of diabetes mellitus were observed in nondiabetic persons. This observation led to the postulation of a new disease entity called hyperinsulinemia.34 Support for the existence of hyperinsulinism was provided from the identification of a malignant pancreatic islet cell tumor in 1926 in a patient who had episodes of severe hypoglycemia.104 Following the death of the patient, postmortem extracts of tissue metastatic to the liver were noted to cause marked hypoglycemia when injected into rabbits. The first surgical cure of hyperinsulinism was reported by Howland and co-workers42 in 1929 following the successful removal of an insulinoma from a hypoglycemic patient. Consequent to the development of a radioimmunoassay for insulin,106 hyperinsulinism was confirmed as the pathophysiologic basis for hypoglycemia caused by insulinoma. Elucidation of the biochemistry of glucose metabolism and hormonal control of glucose counterregulation in the latter part of this century has permitted the identification of other non–insulin-mediated causes of hypoglycemia.
In the two decades after the identification of insulinoma as the cause of hypoglycemia, the focus in patients with hypoglycemia was the pancreas.102 It was recognized that food deprivation provoked hypoglycemia. Consequently, the prolonged (72-hour) fast evolved as the chief diagnostic test when the measurement of blood glucose during a spontaneous episode of hypoglycemia was not feasible. In addition, patients with hyperinsulinism were noted characteristically to experience symptoms of the neuroglycopenic type.
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| Address reprint requests to F. John Service, MD, PhD, Division of Endocrinology, Nutrition, and Metabolism, Mayo Clinic and Foundation, 200 First Street Southwest, Rochester, MN 55905 |
Vol 28 - N° 3
P. 501-517 - septembre 1999 Retour au numéro
Article précédent
- SYMPTOMS OF HYPOGLYCEMIA, THRESHOLDS FOR THEIR OCCURRENCE, AND HYPOGLYCEMIA UNAWARENESS
- Philip E. Cryer
- DIAGNOSTIC APPROACH TO ADULTS WITH HYPOGLYCEMIC DISORDERS
- F. John Service
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