Epidemiology ; Epidemiology ; Clinical Features and Causes of Endogenous Hyperinsulinemic Hypoglycemia in Korea

• Published in: Diabetes & metabolism journal 2015-04, Vol.39 (2), p.126
• Main Authors: Chang Yun Woo, Ji Yun Jeong, Jung Eun Jang, Jaechan Leem, Chang Hee Jung, Eun Hee Koh, Woo Je Lee, Min Seon Kim, Joong Yeol Park, Jung Bok Lee, Ki Up Lee
• Format: Article
• Language: Korean
• Subjects: Autoimmune diseases; Hyperinsulinism; Hypoglycemia; Insulin antibodies; Insulinoma; Nesidioblastosis
• ISSN: 2233-6079

Background: Endogenous hyperinsulinemic hypoglycemia (EHH) is characterized by an inappropriately high plasma insulin level, despite a low plasma glucose level. Most of the EHH cases are caused by insulinoma, whereas nesidioblastosis and insulin autoimmune syndrome (IAS) are relatively rare. Methods: To evaluate the relative frequencies of various causes of EHH in Korea, we retrospectively analyzed 84 patients who were diagnosed with EHH from 1998 to 2012 in a university hospital. Results: Among the 84 EHH patients, 74 patients (88%), five (6%), and five (6%) were diagnosed with insulinoma, nesidioblas tosis or IAS, respectively. The most common clinical manifestation of EHH was neuroglycopenic symptoms. Symptom duration before diagnosis was 14.5 months (range, 1 to 120 months) for insulinoma, 1.0 months (range, 6 days to 7 months) for nesidio blastosis, and 2.0 months (range, 1 to 12 months) for IAS. One patient, who was diagnosed with nesidioblastosis in 2006, under went distal pancreatectomy but was later determined to be positive for insulin autoantibodies. Except for one patient who was diagnosed in 2007, the remaining three patients with nesidioblastosis demonstrated severe hyperinsulinemia (157 to 2,719 μIU/ mL), which suggests that these patients might have had IAS, rather than nesidioblastosis. Conclusion: The results of this study suggest that the prevalence of IAS may be higher in Korea than previously thought. There fore, measurement of insulin autoantibody levels is warranted for EHH patients, especially in patients with very high plasma in sulin levels.