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L’Endocrinologo

, Volume 4, Issue 4, pp 174–186 | Cite as

Diagnosi e terapia dei disturbi ipoglicemici

  • Damiano GulloEmail author
  • Maria Luisa Arpi
Article
  • 50 Downloads

Riassunto

L’ipoglicemia è una sindrome caratterizzata da bassi livelli di glucosio nel sangue che si manifesta con sintomatologia da iperattività adrenergica o disturbi neuroglicopenici. L’ipoglicemia può essere indotta da farmaci (insulina, ipoglicemizzanti orali e alcol), che rappresentano la causa più comune; può essere inoltre associata a varie patologie come tumori, alterata anatomia gastrointestinale, insufficienza di organi endocrini e non endocrini. La diagnosi di ipoglicemia si basa sulla presenza di sintomatologia caratteristica associata a bassa glicemia, con risoluzione dei sintomi dopo somministrazione di glucosio (triade di Whipple). Durante questi episodi, quando possibile, va prelevato un campione di sangue per il dosaggio di insulina, C-peptide e ipoglicemizzanti orali. Se si sospetta un insulinoma può essere necessario ospedalizzare il paziente per eseguire un test del digiuno con monitoraggio di glicemia, insulina, proinsulina e C-peptide. Il digiuno va interrotto alla 72a ora o al momento della comparsa dei sintomi in corrispondenza di bassi livelli di glicemia. Per la diagnosi delle forme “reattive” o funzionali post-prandiali può essere utilizzato il test del pasto misto piuttosto che la curva da carico orale con glucosio, a causa della sua scarsa sensibilità e specificità. La terapia delle ipoglicemie acute consiste nella somministrazione di zucchero o soluzioni glucosate, mentre nei pazienti in stato di incoscienza un valido presidio è costituito dal glucagone per via i.m. Nei pazienti con insulinoma la terapia di scelta è chirurgica, ma in casi non operabili la terapia medica con diazossido può costituire una valida alternativa. Nei casi di ipoglicemia da overdose di ipoglicemizzanti orali, oltre alle soluzioni glucosate per via i.v., è efficace anche l’uso dell’octreotide per via sottocutanea. Nelle forme post-prandiali l’educazione alimentare rappresenta l’approccio principale; nei casi in cui tale presidio è insufficiente sono state tentate in associazione varie terapie farmacologiche.

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Copyright information

© Springer International Publishing AG 2003

Authors and Affiliations

  1. 1.Divisione Clinicizzata di EndocrinologiaOspedale GaribaldiCataniaItalia

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