Successful Medical Treatment of Hyperinsulinemic Hypoglycemia in the Adult: A Case Report and Brief Literature Review
Bibliographic record
Abstract
Hyperinsulinemic hypoglycemia is characterized by inappropriate insulin secretion from the pancreatic beta cells causing low blood glucose levels. Nesidioblastosis is a very rare cause of hyperinsulinemic hypoglycemia in adults. Medical therapy can effectively improve disease symptoms. In 2014, a 45-year-old man presented with recurrent severe fasting and postprandial symptomatic hypoglycemia. The symptoms resolved after glucose ingestion. Fasting test was positive after only 4 h but imaging methods (abdominal computerized tomography, magnetic resonance imaging, endoscopic ultrasonography and octreotide scintigraphy) failed to identify pancreatic lesions. Hypoglycemia in face of endogenous hyperinsulinemia and lack of focal lesions in the pancreas in multiple imaging exams suggested the diagnosis of adult nesidioblastosis. The patient preferred conservative medical treatment in association with dietary recommendations. Nifedipine (30 mg/day) did not improve the glycemic profile and was poorly tolerated by the patient. Diazoxide 150 mg/day was started, with progressive increase to 400 mg/day over 6 weeks. Patient has been successfully treated with medical treatment for 5 years, with no events of severe hypoglycemia, no significant side effects and with marked improvement in quality of life. This clinical case demonstrates that adult hyperinsulinemic hypoglycemia can be effectively controlled with medical treatment, which is a viable alternative to pancreatic surgery. J Endocrinol Metab. 2019;9(6):199-202 doi: https://doi.org/10.14740/jem617
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".