A 61-year-old man recently moved to town and is establishing primary care. During a comprehensive…

A 61-year-old man recently moved to town and is establishing
primary care. During a comprehensive review of systems, he reports that he has
experienced a 3-year history of “hypoglycemic attacks.” These short periods of
light-headedness, confusion, palpitations, and tremor occur more frequently in
the late afternoon while jogging. His symptoms are relieved after drinking a
sugared sports drink. He has no history of diabetes or cancer. His physical
examination is unremarkable, and in the clinic, his fasting morning glucose
level is 93 mg/dL. Suspecting that an insulinomainduced hypoglycemic
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A 61-year-old man recently moved to town and is establishing
primary care. During a comprehensive review of systems, he reports that he has
experienced a 3-year history of “hypoglycemic attacks.” These short periods of
light-headedness, confusion, palpitations, and tremor occur more frequently in
the late afternoon while jogging. His symptoms are relieved after drinking a
sugared sports drink. He has no history of diabetes or cancer. His physical
examination is unremarkable, and in the clinic, his fasting morning glucose
level is 93 mg/dL. Suspecting that an insulinomainduced hypoglycemic state may
be responsible for his symptoms, his physician requests a diagnostic fast
period during which glucose, insulin, and C-peptide levels are measured.

Questions

A. Describe the Whipple triad in the diagnosis of
hypoglycemia.

B. What patient history clues suggest insulinoma? Discuss
the pathogenesis.

C. How might the tests ordered help identify the cause of
the hypoglycemia?

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