• Annals of Pediatric Endocrinology and Metabolism
• /
• v.23 no.4
• /
• pp.226-228
• /
• 2018

Various endocrine dysfunctions occur during chemotherapy, including hypoglycemia. However, reports of hypoglycemia associated with 6-mercaptopurine (6-MP) are rare. Herein, we report an 8-year-old boy with severe symptomatic hypoglycemia likely due to 6-MP during chemotherapy. He had been diagnosed with acute lymphoblastic leukemia 3 years previously and was in the maintenance chemotherapy period. Treatment included oral dexamethasone, methotrexate, and 6-MP, of which only 6-MP was administered daily. Hypoglycemic symptoms appeared mainly at dawn, and his serum glucose dropped to a minimum of 37 mg/dL. Laboratory findings showed nothing specific other than increased serum cortisol, free fatty acids, ketone, alanine aminotransferase, and aspartate aminotransferase. Under the hypothesis of hypoglycemia due to chemotherapy drugs, we changed the time of 6-MP from evening to morning and recommended him to ingest carbohydrate-rich foods before bedtime. Hypoglycemia improved dramatically, and there was no further episode during the remaining maintenance chemotherapy period. To the best of our knowledge, this is the first report of this type of hypoglycemia occurring in an Asian child including Korean.

• Journal of Chest Surgery
• /
• v.21 no.3
• /
• pp.558-562
• /
• 1988

Localized mesothelioma is a primary pleural tumor that induces hypoglycemia rarely. We experienced a case of the localized mesothelioma that induced hypoglycemia. The patient was 70 year-old man who was admitted to Severance Hospital because of general weakness and mental confusion in morning before breakfast. He was found to have low level of fasting blood sugar and C-peptide, but had normal serum insulin level. After excision of the tumor, the patient was free from symptoms of hypoglycemia, and fasting blood sugar level was returned to normal range. The most likely speculation of causing hypoglycemia by the mesothelioma was thought to be that the tumor did not secrete insulin itself but the undetectable insulin-like substance and/or antigluconeogenic substances. During the follow up, 5 months after surgical removal of tumor, the patient was in a good condition without symptoms of hypoglycemia.

• Journal of Neurocritical Care
• /
• v.11 no.2
• /
• pp.143-147
• /
• 2018

Background: Hypoglycemia is uncommon in people without diabetes. There have been only a few reports of cardiac arrest in conjunction with hypoglycemia in non-diabetic patients. Case Report: A 66-year-old man visited the emergency room with dizziness. He was a chronic alcoholic. Laboratory test showed no evidence of diabetes mellitus. Brain magnetic resonance imaging revealed a left cerebellar infarction. Abdomen computed tomography demonstrated liver cirrhosis with minimal ascites. During his hospital stay, he consumed only a small amount of food because of nausea and headache. On hospital day 4, he had a cardiac arrest after two seizure episodes. His blood glucose was 10 mg/dL. The combination of liver cirrhosis, renal failure and poor oral intake was presumed to be the causes of the severe hypoglycemia. Conclusion: We report a rare case of cardiac arrest occurring in conjunction with severe hypoglycemia in a non-diabetic patient with cerebral infarction.

• The Journal of Korea Assosiation for Disability and Oral Health
• /
• v.3 no.1
• /
• pp.22-25
• /
• 2007

Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) characterized by severe hypoglycemia caused by inappropriate over secretion of insulin is the most common cause of hypoglycemia in early infancy. The symptoms of hypoglycemia in neonate and infancy are neonatal sepsis, respiratory difficulty, tachypnea, apnea, cyanosis, and seizure. Especially the recurrent and severe hypoglycemia within $1^{st}$ year of life is responsible for severe and irreversible brain damage. To prevent it aggressive treatment is required. Due to severe and irreversible brain damage these children frequently require anesthesia during imaging procedures such as MRI or during various dental surgical procedures. Because of frequent hypoglycemia and dental phobia in children with neurologic disorder, anesthesiologists should pay attention to patient. We report a successful anesthetic management in a patient with PHHI for dental procedures.

• Clinical and Experimental Pediatrics
• /
• v.50 no.3
• /
• pp.223-229
• /
• 2007

The fetus is completely dependent on mother for glucose and other nutrient transfer across the placenta. At birth, when the maternal supply is discontinued, the neonate must adjust to an independent existence. The changes in the neonate's glucose homeostasis during this transition to the extrauterine environment are influenced by the mother's metabolism and intrinsic fetal and placental problems. Maturation of carbohydrate homeostasis results from a balance between substrate availability and coordination of developing hormonal, enzymatic, and neural systems. These mechanisms may not be fully developed in neonates, so the neonate is vulnerable to carbohydrate disequilibrium resulting in damage to the central nervous system. Hypoglycemia is a relatively common metabolic problem seen during newborn care. However its definition, management and long term sequalae remain controversial. Hyporglycemia occurs frequently as a transient disorder with excellent prognosis. It also may persist and recur and cause permanent neurological complications. Although the key to effective treatment of hypoglycemia is diagnostic specific, the maintenance of euglycemia is critical to the preservation of central nervous system function. This article discusses physiology of perinatal glucose homeostasis, focusing on evaluation and treatment of hypoglycemia.

• Neonatal Medicine
• /
• v.15 no.1
• /
• pp.94-99
• /
• 2008

Although neonatal hypoglycemia is a common metabolic abnormality in newborn infants, brain injuries resulting from isolated neonatal hypoglycemia are rare. Many infants who are hypoglycemic do not exhibit clinical manifestations, while other infants are symptomatic and at risk for permanent brain damage. There is no disagreement that hypoglycemia can cause neonatal encephalopathy and result in permanent brain injury. Occipital brain injury associated with neonatal hypoglycemia can result in long-term disability, epilepsy, and visual impairment. Infants should receive ongoing developmental and visual surveillance for lateonset epilepsy, and visual or cognitive impairment. We report two cases of newborn infants with abnormal visual evoked potentials (VEP) caused by neonatal hypoglycemic encephalopathy.

• Journal of Veterinary Science
• /
• v.24 no.3
• /
• pp.39.1-39.6
• /
• 2023

A 7-year-old spayed female Shih Tzu dog was presented for evaluation of recurrent hypoglycemia. Serum insulin levels during hypoglycemia were 35.3 µIU/mL. Ultrasonography and computed tomography showed a mesenteric nodule between the kidney and the portal vein, but no pancreatic mass was observed. During surgery, the nodule had neither anatomical adhesions nor vascular connections to the pancreas. Pancreatic inspection and palpation revealed no abnormalities. Hypoglycemia improved after resection of the nodule. Histopathological examination confirmed the nodule to be an islet cell carcinoma. Although extremely rare, ectopic insulinoma should be considered as a possible cause of insulininduced hypoglycemia in dogs.

• The Korean Journal of Physiology and Pharmacology
• /
• v.17 no.5
• /
• pp.441-446
• /
• 2013

In the present study, the anti-depressant like effect of methyl gallate (MG) isolated from the stem bark of Acer barbinerve was examined in ICR mice. Body weight (BDW) and blood glucose (BDG) levels significantly decreased in the repeated restraint stress (RRS) group (2 h/day for 14 days) compared to the no stress (NS) group. To examine the effect of MG on RS-induced BDW loss and hypoglycemia, MG (10 mg/kg) and the anti-depressant fluoxetine (10 mg/kg) were administered daily for 14 days. Orally administered MG and fluoxetine significantly attenuated the RS-induced BDW loss and hypoglycemia. Interestingly, MG administered mice showed increased BDG levels in the normal and glucose feeding condition. Chronic RS-subjected mice showed immobilized and depressed behaviors. The effect of MG on the depressed behaviors was evaluated using the tail-suspension test (TST) and the forced swimming test (FST). In both tests, RS-induced immobilized behaviors were significantly reversed in MG and fluoxetine administered groups. Taken together, MG significantly attenuated the RS-induced BDW loss, hypoglycemia, and depressed behaviors. Considering that decreased BDG levels (hypoglycemia) can cause depression, MG may exert its anti-depressant like effect by preventing hypoglycemia. Our results suggest that MG isolated from A. barbinerve can exert anti-depressant like effect, and could be used as a new and natural anti-depressant therapy.

• Journal of Yeungnam Medical Science
• /
• v.28 no.1
• /
• pp.77-83
• /
• 2011

Non-islet cell tumor-induced hypoglycemia (NICTH) is associated with mesenchymal tumor types, including hemangiopericytoma, fibrosarcoma, mesothelioma, and neurofibroma, as well as carcinoma of the liver, adrenal glands, and kidneys. Non- islet cell tumors induce hypoglycemia by overproducing an abnormal form of insulin-like growth factor II (IGF m. Complete removal of the tumor or reduction of the tumor mass is a successful therapeutic strategy in cases of NICTH. However, if the tumor re-grows, curative resection is nearly impossible, and hypoglycemia occurs repeatedly. Glucocorticoids are effective in terms of long-term relief from hypoglycemia through promotion of gluconeogenesis in the liver, tumor suppression, production of 'big'-IGF-II, and correction of the attendant biochemical abnormalities involving the growth hormone (GH)-IGF axis. We found that administration of corticosteroid therapy to a patient suffering from NICTH resulted in improvement of hypoglycemia associated symptoms.

• Clinical and Experimental Pediatrics
• /
• v.59 no.sup1
• /
• pp.116-120
• /
• 2016

Congenital hyperinsulinism (CHI) is a rare condition that can cause irreversible brain damage during the neonatal period owing to the associated hypoglycemia. Hypoglycemia in CHI occurs secondary to the dysregulation of insulin secretion. CHI has been established as a genetic disorder of islet-cell hyperplasia, associated with a mutation of the ABCC8 or KCNJ11 genes, which encode the sulfonylurea receptor 1 and the inward rectifying potassium channel (Kir6.2) subunit of the ATP-sensitive potassium channel, respectively. We report the case of a female newborn infant who presented with repetitive seizures and episodes of apnea after birth, because of hypoglycemia. Investigations revealed hypoglycemia with hyperinsulinemia, but no ketone bodies, and a low level of free fatty acids. High dose glucose infusion, enteral feeding, and medications could not maintain the patient's serum glucose level. Genetic testing revealed a new variation of ABCC8 mutation. Therefore, we report this case of CHI caused by a novel mutation of ABCC8 in a half-Korean newborn infant with diazoxide-unresponsive hyperinsulinemic hypoglycemia.