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Manifestations of hyperinsulinemic hypoglycemia vary by age and severity of the hypoglycemia. In general, most signs and symptoms can be attributed to (1) the effects on the brain of insufficient glucose (neuroglycopenia) or (2) to the adrenergic response of the autonomic nervous system to hypoglycemia. A few miscellaneous symptoms are harder ...
Nesidioblastosis is a controversial medical term for hyperinsulinemic hypoglycemia attributed to excessive insulin production by pancreatic beta cells that have an abnormal microscopic appearance. The term was coined in the first half of the 20th century.
In adults, severe hyperinsulinemic hypoglycemia is often due to an insulinoma, an insulin-secreting tumor of the pancreas. [citation needed] Insulin levels above 3 μU/mL are inappropriate when the glucose level is below 50 mg/dL (2.8 mM), and may indicate hyperinsulinism as the cause of the hypoglycemia.
Recurrent mild hypoglycemia may fit a reactive hypoglycemia pattern, but this is also the peak age for idiopathic postprandial syndrome, and recurrent "spells" in this age group can be traced to orthostatic hypotension or hyperventilation as often as demonstrable hypoglycemia. [citation needed] Insulin-induced hypoglycemia
[3] [2] Post-gastric bypass hypoglycemia can be prevented by eating smaller, more frequent meals, avoiding sugar-filled foods, as well as medical treatment with an alpha-glucosidase inhibitor, diazoxide, or octreotide. [3] [2] Some causes of hypoglycemia require treatment of the underlying cause to best prevent hypoglycemia. [2]
Congenital hyperinsulinism (HI) has been referred to by a variety of names; nesidioblastosis and islet cell adenomatosis were favored in the 1970s, beta cell dysregulation syndrome or dysmaturation syndrome in the 1980s, and persistent hyperinsulinemic hypoglycemia of infancy (PHHI) in the 1990s.
Mutations in the monocarboxylate transporter 1 (MCT1) gene have been associated with three diseases: hyperinsulinemic hypoglycemia, familial 7 (HHF7); monocarboxylate transporter 1 deficiency (MCTD1); and erythrocyte lactate transporter defect (formerly, myopathy due to lactate transport defect). [9] (See also bioenergetic systems.)
In the pancreatic beta-cell, glucokinase is a key regulator enzyme. Glucokinase is very important in the regulation of insulin secretion and has been known as the pancreatic beta-cell sensor. Mutations in the gene encoding glucokinase can cause both hyperglycemia and hypoglycemia because of its central role in the regulation of insulin release ...