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 (shaking)]
      • Abdomen (abdomen)
        • Shape of the abdomen?
        • Skin color? Skin texture?
        • Efflorescences (skin changes)?
        • Pulsations? Bowel movements?
        • Visible vessels?
        • Scars? Hernias (fractures)?
    • Auscultation (listening) of the heart [tachycardia? (palpitations)]
    • Auscultation of the lungs
    • Examination of the abdomen
      • Auscultation of the abdomen [vascular or stenotic sounds?]
      • Percussion (tapping) of the abdomen.
        • [Attenuation of tapping sound due to enlarged liver or spleen, tumor, urinary retention?
        • Hepatomegaly (liver enlargement) and/or splenomegaly (spleen enlargement): estimate liver and spleen size]
      • Palpation of the abdomen (tenderness?, tapping pain?, coughing pain?, guarding?, hernial orifices?, renal bed tenderness?).
  • Neurological examination – due toneuroglycopenic signs: These signs result from glucose deficiency in the central nervous system (CNS) (occurrence usually only at blood glucose concentrations < 50 mg/dl). [Glycopenia affects numerous neuronal functions and manifests as follows, among others:
    • Atypical behavior (aggressiveness; anxiety).
    • Drowsiness
    • Paresthesias (non-painful sensation in the area supplied by a cutaneous nerve with signs such as: Tingling, “formication”, furriness, tingling, itching, etc.).
    • Speech disorders (aphasia)
    • Visual disturbances (blurred vision, double vision).
    • Confusion
    • Transient hemiplegia (temporary hemiplegia).
    • Psychosis or delirium If blood glucose levels continue to fall (< 30-40 mg/dl), severe neurological disorders develop:
      • Epilepsy (seizures).
      • Unconsciousness
      • Coma]
  • Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.