Hyperinsulinism

Hyperinsulinism (hypoglycemic disease) - a disease characterized by bouts of hypoglycemia, caused by an absolute or relative increase in insulin levels.

Etiology, pathogenesis. Tumors of the islets of Langerhans (insulinoma), diffuse hyperplasia of the beta cells of the pancreas, diseases of the central nervous system, liver, extrapank-tumoral tumors secreting insulin-like substances, tumors (often of connective tissue origin), intensively absorbing glucose, insufficient production of counterinsulant hormones. Hypoglycemia leads to a violation of the functional state of the central nervous system, an increase in activity of the sympathetic-adrenal system.

Symptoms, course. They are ill at the age of 26-55 years, more often women. Attacks of hypoglycemia occur usually in the morning on an empty stomach, after prolonged fasting; And with functional hyperinsulinism - after taking carbohydrates. Physical load, mental experiences can be provocative moments. In women, at first, seizures can be repeated only in the premenstrual period.

The onset of an attack is characterized by a feeling of hunger, sweating, weakness, trembling of the limbs, tachycardia, a sense of fear, pallor, diplopia, paresthesia, mental arousal, unmotivated acts, disorientation, dysarthria; Later there are loss of consciousness, clinical and tonic convulsions, sometimes reminiscent of epileptic attack, coma with hylothermia and hyporeflexia. Sometimes seizures begin with sudden loss of consciousness. In the interictal period, symptoms appear due to CNS damage: memory loss, emotional imbalance, indifference to the environment, loss of professional skills, sensitivity disorders, paresthesia, pyramidal insufficiency symptoms, pathological reflexes. Because of the need for frequent meals, patients have an excess body weight.

For diagnosis, the determination of blood sugar, immunoreactive insulin and C-peptide (fasting and against a background of a sample with fasting and a glucose tolerance test) is performed. For topical diagnosis, pancreatic angiography, ultrasound, computed tomography, retrograde pancreatoduodenography are used.

Treatment of insulinoma and tumors of other organs that cause the development of hypoglycemic conditions, surgical. With functional hyperinsulinism, fractional nutrition with restriction of carbohydrates, corticosteroids (prednisolone 5-15 mg / day) is prescribed. Attacks of hypoglycemia are stopped by intravenous administration of 40-GO ml of 40% glucose solution.