Metabolic Disorders

Hyperinsulinism: Or something else? Differential Diagnosis

Endocrine, nutritional, and metabolic diseases (E00-E90). Obesity (obesity) Autoantibodies against insulin Diabetes mellitus type 2 (age-related diabetes) – leads to peripheral insulin resistance (reduced effectiveness of endogenous insulin at target organs skeletal muscle, adipose tissue and liver). Ectopic insulin secretion – secretion of insulin from a site other than the pancreas (pancreas). Congenital hyperinsulinemia (CHI) … Hyperinsulinism: Or something else? Differential Diagnosis

Acromegaly: Causes

Pathogenesis (disease development) Acromegaly is caused by overproduction of growth hormone (GH). The cause of this overproduction is usually a tumor. It is a somatotrophic pituitary adenoma (benign neoplasm) in 99% of cases. A distinction is made between microadenomas and macroadenomas (> 1 cm). In 2017, the World Health Organization updated the histologic grading of … Acromegaly: Causes

Hyperinsulinism: Complications

The following are the most important diseases or complications that may be contributed to by hyperinsulinism: Endocrine, nutritional, and metabolic diseases (E00-E90). Obesity (obesity) Hypernatremia (excess sodium → volume expansion). Hypoglycemic coma – severe disturbance of consciousness induced by hypoglycemia. Hypokalemia (potassium deficiency). Cardiovascular system (I00-I99) Atherosclerosis (arteriosclerosis, hardening of the arteries) is forced by … Hyperinsulinism: Complications

Acromegaly: Therapy

General measures Aim for normal weight! Determine BMI (body mass index) or body composition using electrical impedance analysis. BMI ≥ 25 → participation in a medically supervised weight loss program. Falling below the BMI lower limit (from the age of 45: 22; from the age of 55: 23; from the age of 65: 24) → … Acromegaly: Therapy

Hyperinsulinism: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection Skin, mucous membranes, and sclerae (white part of the eye) [Autonomic signs (synonym: adrenergic signs) – these result from reactive adrenaline release. These signs include: Paleness Ravenous hunger Sweating Tremor … Hyperinsulinism: Examination

Hyperinsulinism: Test and Diagnosis

1st order laboratory parameters – obligatory laboratory tests. Fasting insulin [Homa index: see “Fasting insulin” below] C-peptide (part of proinsulin; indicator of beta cell function/insulin-producing cells in the islets of Langerhans of the pancreas (pancreas); decreased levels: including diabetes mellitus, starvation; increased levels: including insulinoma, metabolic syndrome, renal function impairment). Fasting glucose (fasting blood glucose). … Hyperinsulinism: Test and Diagnosis

Hyperinsulinism: Diagnostic Tests

Obligatory medical device diagnostics. Abdominal ultrasonography (ultrasound examination of the abdominal organs) – for basic diagnosis. Optional medical device diagnostics – depending on the results of the history, physical examination and obligatory laboratory parameters – for differential diagnostic clarification. Computed tomography (CT) of the abdomen (abdominal CT) – for further diagnosis of suspected neoplasms.

Hyperinsulinism: Prevention

To prevent hyperinsulinism, attention must be paid to reducing individual risk factors. Behavioral risk factors Diet High-carbohydrate diet (mainly of glucose and sucrose (sugar); e.g., also consumption of soft drinks with sugar). High-fat diet (saturated fat)Note: A flavored palm oil drink led to a reduction in insulin sensitivity or insulin resistance, as well as increased … Hyperinsulinism: Prevention

Hyperglycemia: Causes

Pathogenesis (development of disease) The cause of hyperglycemia is either impaired insulin secretion and/or impaired insulin action (insulin resistance). Hyperglycemia is the result of a disturbance in the coordination or regulation between glucose delivery by the liver, ie, from the glycogen reservoir or by gluconeogenesis, and glucose uptake by the consuming organs. Regulation is by … Hyperglycemia: Causes

Hyperglycemia: Therapy

If diabetes mellitus disease is present, see regarding “Further Therapy” under corresponding disease. General Measures Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day) – Wines with high sugar content (Spätlese, Auslese, dessert wines), liqueurs and spirits are to be avoided. Aim for normal weight! Determination of … Hyperglycemia: Therapy

Hypoglycemia (Low Blood Sugar): Medical History

Medical history (history of illness) represents an important component in the diagnosis of hypoglycemia (hypoglycemia). Family history Social history What is your occupation? Do you work hard physically? Current medical history/systemic history (somatic and psychological complaints). What symptoms have you noticed? Paleness Ravenous hunger Palpitations Sweating Palpitations Tremor How long have these symptoms been present? … Hypoglycemia (Low Blood Sugar): Medical History

Hypoglycemia (Low Blood Sugar): Or something else? Differential Diagnosis

Endocrine, nutritional, and metabolic diseases (E00-E90). Adrenocortical insufficiency (NNR insufficiency). Pseudohypoglycemia – occurrence of symptoms of hypoglycemia without the blood glucose level being decreased; this phenomenon not infrequently occurs after glycemic control of a type 2 diabetic, the more pronounced the higher the baseline HbA 1c was Cardiovascular system (I00-I99). Apoplexy (stroke) Psyche – nervous … Hypoglycemia (Low Blood Sugar): Or something else? Differential Diagnosis