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Diagnosi dell’ipoglicemia nell’adulto non diabetico

Sommario

Nei soggetti adulti non diabetici che presentano ipoglicemia (glucosio \(<55~\text{mg/dL}\)) è necessario documentare la presenza di 3 condizioni, triade di Whipple: bassi valori glicemici, segni e sintomi clinici compatibili con l’ipoglicemia e loro risoluzione dopo aumento della glicemia. L’ipoglicemia può essere secondaria a farmaci (anche a uso surrettizio), a neoplasie (insulinomi), a sindromi autoimmuni (acido alfa lipoico), a forme reattive (idiopatiche, chirurgia dell’apparato digerente, prediabete). L’intossicazione da alcool e le malattie gravi come l’insufficienza epatica, lo scompenso cardiaco e la sepsi possono anche essere associate a ipoglicemia. Per indirizzare il paziente nel corretto percorso di diagnosi, per le forme tumorali o autoimmuni sono stati definiti protocolli standardizzati, diversamente da quanto accade per le forme reattive o post-prandiali, per le quali non sono ancora disponibili percorsi diagnostici condivisi e, pertanto, l’esame clinico e anamnestico svolgono un ruolo essenziale.

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Bibliografia

  1. Ben Salem C, Fathallah N, Hmouda H et al. (2011) Drug-induced hypoglycaemia: an update. Drug Safety 34(1):21–45

    CAS  Article  Google Scholar 

  2. de Herder WW, Zandee WT, Hofland J (2000) Insulinoma. In: Feingold KR, Anawalt B, Boyce A et al. (eds) Endotext [Internet]. MDText.com, South Dartmouth (MA)

    Google Scholar 

  3. Placzkowski KA, Vella A, Thompson GB et al. (2009) Secular trends in the presentation and management of functioning insulinoma at the Mayo Clinic 1987–2007. J Clin Endocrinol Metab 94(4):1069–1073

    CAS  Article  Google Scholar 

  4. Gullo D, Magliozzo M, Strano A et al. (2020) Insulin autoimmune syndrome misdiagnosed as an insulinoma in a woman presenting with a pancreatic cystic lesion and taking alpha lipoic acid: a lesson to be learned. Hormones (Athens). https://doi.org/10.1007/s42000-020-00261-3

    Article  Google Scholar 

  5. ENETS (2017) Consensus guidelines for the standards of care in neuroendocrine tumors: radiological, nuclear medicine & hybrid imaging. Neuroendocrinology 105(3):212–244

    Article  Google Scholar 

  6. Dynkevich Y, Rother KI, Whitford I et al. (2013) Tumors, IGF-2, and hypoglycemia: insights from the clinic, the laboratory, and the historical archive. Endocr Rev 34(6):798–826

    CAS  Article  Google Scholar 

  7. Gullo D, Sciacca L, Parrinello G et al. (1999) Treatment of hemangiopericytoma-induced hypoglycemia with growth hormone and corticosteroids. J Clin Endocrinol Metab 84(5):1758–1759

    CAS  Article  Google Scholar 

  8. Gullo D, Evans JL, Sortino G et al. (2014) Insulin autoimmune syndrome (Hirata Disease) in European Caucasians taking \(\alpha \)-lipoic acid. Clin Endocrinol (Oxf) 81(2):204–209

    CAS  Article  Google Scholar 

  9. Cappellani D, Macchia E, Falorni A et al. (2020) Insulin autoimmune syndrome (Hirata Disease): a comprehensive review fifty years after its first description. Diabetes Metab Syndr Obes 13:963–978

    CAS  Article  Google Scholar 

  10. Bresciani E, Bussi A, Bazzigaluppi E et al. (2011) Insulin autoimmune syndrome induced by \(\alpha \)-lipoic acid in a Caucasian woman: case report. Diabetes Care 34(9):e146

    Article  Google Scholar 

  11. Veltroni A, Zambon G, Cingarlini S et al. (2018) Autoimmune hypoglycaemia caused by alpha-lipoic acid: a rare condition in Caucasian patients. Endocrinol Diabetes Metab Case Rep 2018:18

    PubMed Central  Google Scholar 

  12. Moffa S, Improta I, Rocchetti S et al. (2019) Potential cause-effect relationship between insulin autoimmune syndrome and alpha lipoic acid: two case reports. Nutrition 57:1–4

    CAS  Article  Google Scholar 

  13. Lupoli R, Cotugno M, Griffo E et al. (2015) Role of the entero-insular axis in the pathogenesis of idiopathic reactive hypoglycemia: a pilot study. J Clin Endocrinol Metab 100(12):4441–4446

    CAS  Article  Google Scholar 

  14. Soare A, Khazrai YM, Fontana L et al. (2017) Treatment of reactive hypoglycemia with the macrobiotic Ma-pi 2 diet as assessed by continuous glucose monitoring: the MAHYP randomized crossover trial. Metabolism 69:148–156

    CAS  Article  Google Scholar 

  15. Scarpellini E, Arts J, Karamanolis G et al. (2020) International consensus on the diagnosis and management of dumping syndrome. Nat Rev Endocrinol 16(8):448–466

    Article  Google Scholar 

  16. Kanat M, Mari A, Norton L et al. (2012) Distinct \(\beta \)-cell defects in impaired fasting glucose and impaired glucose tolerance. Diabetes 61(2):447–453

    CAS  Article  Google Scholar 

  17. Kushimoto S, Abe T, Ogura H et al. (2020) JAAM FORECAST group. Impact of blood glucose abnormalities on outcomes and disease severity in patients with severe sepsis: an analysis from a multicenter, prospective survey of severe sepsis. PLoS ONE 15(3):e0229919

    CAS  Article  Google Scholar 

  18. Dauben L, Simon MC, Strassburger K et al. (2019) Comparison of the diagnostic accuracy of the current guidelines for detecting insulinoma. Eur J Endocrinol 180(6):381–386

    CAS  Article  Google Scholar 

  19. Cryer PE, Axelrod L, Grossman AB et al. (2009) Endocrine Society. Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 94(3):709–728

    CAS  Article  Google Scholar 

  20. Gullo D, Arpi ML (2003) Diagnosi e terapia dei disturbi ipoglicemici. Endocrinologo 4:174–186

    Article  Google Scholar 

  21. Charles MA, Hofeldt F, Shackelford A et al. (1981) Comparison of oral glucose tolerance tests and mixed meals in patients with apparent idiopathic postabsorptive hypoglycemia: absence of hypoglycemia after meals. Diabetes 30(6):465–470

    CAS  Article  Google Scholar 

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Correspondence to Damiano Gullo.

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Gli autori Damiano Gullo, Miriam Magliozzo, Antonino Belfiore e Maria Luisa Arpi dichiarano di non avere conflitti di interesse.

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Gullo, D., Magliozzo, M., Belfiore, A. et al. Diagnosi dell’ipoglicemia nell’adulto non diabetico. L'Endocrinologo 22, 298–304 (2021). https://doi.org/10.1007/s40619-021-00925-1

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Parole chiave

  • Ipoglicemia non diabetica
  • Insulinoma
  • Sindrome insulinica autoimmune
  • Ipoglicemia reattiva