c-peptide and Seizures

History and admission findings | A 41year old woman presented at our internistic clinic after treatment by an emergency doctor because of confusion and amnesia accompanied by a hypoglycaemic episode while driving her car. Only by giving continuous glucose intravenously a stable clinical state could be achieved. In her medical history she took Lamotrigin for 12 years since she had seizures of unknown aetiology. 16 years ago she had similar sudden attacks with confusion and hypoglycaemia. At that time thorough diagnostics at the clinic for internal medicine did not reveal any evidence for hyperinsulinaemia. While taking Lamotrigin the patient had no seizures or similar symptoms for 12 years. Treatment and course | In the present case we detected a tumor in the pancreas and a two-fold increased insulin secretion. Histopathological work-up of the removed tissue confirmed the suspected diagnosis of insulinoma. Postoperatively, Lamotrigin treatment was terminated. Since then the patient remained asymptomatic.

Topics: Adult; Amnesia; Anticonvulsants; C-Peptide; Confusion; Endosonography; Female; Glucose Tolerance Test; Humans; Hypoglycemia; Insulin; Insulinoma; Lamotrigine; Pancreatic Neoplasms; Recurrence; Seizures; Tomography, X-Ray Computed; Triazines

A diabetic patient with chronic renal failure who developed recurrent and prolonged episodes of hypoglycemia associated with use of sulfonylurea agent is presented here. This patient was hospitalized with neuroglycopenic symptoms of hypoglycemia that persisted in spite of large doses of parenteral glucose replacement. On administration of somatostatin analogue octreotide, hypoglycemia resolved and, blood glucose levels were maintained even after cessation of parenteral glucose. The patient received 2 subcutaneous doses of octreotide 12 hours apart, and made a complete recovery. Our experience suggests that use of octerotide to treat refractory or prolonged sulfonylurea-included hypoglycemia in renal failure patients is safe and effective; large prospective studies would be needed to validate these findings.

Topics: Adult; C-Peptide; Diabetes Mellitus, Type 2; Gastrointestinal Agents; Glipizide; Humans; Hypoglycemia; Hypoglycemic Agents; Kidney Failure, Chronic; Male; Octreotide; Seizures

Hyperinsulinemic hypoglycemia associated with trimethoprim-sulfamethoxazole (TMP-SMX) has generally been reported in adults who had renal impairment or in patients with AIDS using high dose TMP-SMX. We present a 5 month-old infant with immunodeficiency due to major histocompatibility complex class II expression defect, developing hypoglycemic convulsion on the third day of high dose TMP-SMX administration. High insulin and C-peptide levels were documented at the time of hypoglycemia. To overcome hypoglycemia while TMP-SMX tapered off, diazoxide was administered which resolved hypoglycemia in 2 months.

Topics: Blood Glucose; C-Peptide; Diazoxide; Drug Administration Schedule; Female; Gene Expression; Genes, MHC Class II; Glucose; Histocompatibility Antigens Class II; Hospitalization; Humans; Hyperinsulinism; Hypoglycemia; Immunologic Deficiency Syndromes; Infant; Infusions, Intravenous; Pneumonia; Seizures; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination