, Volume 31, Issue 2, pp 444-445
Date: 05 Jan 2007


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We have read with interest the well taken queries put forward by Mishra et al. in response to our publication on islet-cell hyperplasia in adults1 and would like to answer as follows:

  1. Mishra et al. correctly noticed that in contrast to Service and Thompson,2,3 we have seen both, fasting hypoglycemia and typical postprandial hypoglycemia, in most of our published patients. Since in our institution an initial oral glucose load routinely always precedes the standard fasting test as an integral part of this classical suppression test, there was no need to develop a specific diagnostic strategy in patients suspected to suffer from any form of clinically relevant hypoglycemia, be it classical insulinoma or NIPHS. Indeed, we strongly advocate initial glucose loading to precede the supervised fasting test. Any such procedure with the first sample drawn typically after an overnight fast would miss the postprandial phase during the night and be already in the 12th hour in most cases. As to our ...