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Corticotrophin deficiency in end-stage renal failure led to recurrent hypoglycemia: A case report

机译：终末期肾功能衰竭中促肾上腺皮质激素缺乏导致复发性低血糖：一例报告

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Reactive hypoglycemia caused by an insulinoma, pre-diabetic metabolic state, fluctuations in diabetic metabolic situation and antidiabetic medication is commonly known. We report on the case of an unusual multi-factorial occurrence of a woman with recurrent hypoglycemia, which cannot be explained adequately by a single commonly known cause. We refer to a cachectic non-diabetic 52-year-old German woman, admitted to our clinic for clarification of an insulinoma. The possibility of an insulinoma could be excluded as well as co-morbidities linked to non-diabetic hypoglycemia like sepsis, alcohol dependence liver disease, cancer or self-harm with hypoglycaemic agents. However, our diagnostics revealed a corticotrophic insufficiency as a result of longtime cortisol medication. Still, further causes have additionally to be considered, including dysfunctional elimination of glucose, renal and hepatic gluconeogenesis and glucose regulation on dialysis. These reasons are assumed as the pathological factors. Although insulinoma is a possible cause of hypoglycemia, it is not the only pathogenesis. Here, various alternatives factors are defined, examined and in part treated specifically. As therapy, besides nutritional counselling, the patient received cortisol. After a 20 month follow-up symptoms of symptomatic hypoglycemia were absent.
机译：由胰岛素瘤，糖尿病前代谢状态，糖尿病代谢状况的波动和抗糖尿病药物引起的反应性低血糖是众所周知的。我们报道了一名反复发作性低血糖的妇女异常多因素发生的情况，这不能由一个众所周知的原因充分解释。我们指的是一名恶病质的非糖尿病52岁德国妇女，她因进入胰岛素瘤的治疗而进入我们的诊所。可以排除胰岛素瘤的可能性以及与非糖尿病性低血糖症相关的合并症，例如败血症，酒精依赖的肝病，癌症或降血糖药的自我伤害。但是，我们的诊断显示，长期服用皮质醇治疗导致皮质营养不足。此外，还需要考虑其他原因，包括葡萄糖功能失调，肾脏和肝脏糖原异生以及透析时的葡萄糖调节。这些原因被认为是病理因素。尽管胰岛素瘤是低血糖的可能原因，但它不是唯一的发病机理。在这里，各种替代因素被定义，检查和部分处理。作为治疗方法，除了营养咨询外，患者还接受了皮质醇。经过20个月的随访，无症状性低血糖症状。

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