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Pancreatic Disease
Pancreatic Disease

 

 

 

Definition:

Glucagonomas are rare type of pancreatic neuroendocrine tumors that secrete excessive level of glucagon. Glucagon, acting on the liver, increases both amino acid oxidation and gluconeogenesis from amino acid substrates. High amounts of glucagon can cause glucose intolerance, weight loss and migratory necrolytic erythema. The weight loss in glucagonoma may cause from the catabolic action of glucagon and through glucagon-like peptides such as GLP-1. Necrolytic migratory erythema may result from hyponitrite Hepatocellular carcinoma (HCC) tumors are among the most common in the world, particularly in populations with chronic viral hepatitis, such as those of Asian or sub-Saharan African ancestry. Most occur in individuals with chronic liver disease. On and amino acid deficiency. Diarrhea may result from hyperglucagonemia and co-secretion of gastrin, vasoactive intestinal peptide, serotonin, or calcitonin Glucagonomas are usually solitary, and the most are localized in the distal pancreas.

 

Panel test:

·        Insulin, Fasting

  • C-Peptide (Serum or Plasma)
  • Gastrin
  • Glucagon
  • Vasoactive intestinal peptide
  • Somatostatin (plasma)
  • Chromogranin A

 

References

Guidelines

  1. Protocol for the Examination of Specimens from Patients with Tumors of the Endocrine Pancreas. Based on AJCC/UICC TNM, 7th ed. Protocol web posting date: Aug 2016. College of American Pathologists (CAP). Northfield, IL [Revised: Aug 2016; Accessed: July 2018]
  2. Protocol for the Examination of Specimens from Patients with Neuroendocrine Tumors (Carcinoid Tumors) of the Stomach. Based on AJCC/UICC TNM, 7th ed. Protocol web posting date: Oct 2013. College of American Pathologists (CAP). Northfield, IL [Revised: Jun 2014; Accessed: Mar 2018]
  3. Protocol for the Examination of Specimens from Patients with Neuroendocrine Tumors (Carcinoid Tumors) of the Small Intestine and Ampulla. Based on AJCC/UICC TNM, 7th ed. Protocol web posting date: Oct 2013. College of American Pathologists (CAP). Northfield, IL [Revised: Oct 2013; Accessed: Mar 2018]
  4. NCCN Clinical Practice Guidelines in Oncology, Neuroendocrine and Adrenal Tumors. Version 4.2018. National Comprehensive Cancer Network. Fort Washington, PA [Updated: May 2018; Accessed: Jul 2018]
  5. Strosberg JR, Halfdanarson TR, Bellizzi AM, Chan JA, Dillon JS, Heaney AP, Kunz PL, O’Dorisio TM, Salem R, Segelov E, Howe JR, Pommier RF, Brendtro K, Bashir MA, Singh S, Soulen MC, Tang L, Zacks JS, Yao JC, Bergsland EK. The North American Neuroendocrine Tumor Society Consensus Guidelines for Surveillance and Medical Management of Midgut Neuroendocrine Tumors. 2017; 46(6): 707-714. PubMed
  6. Garcia-Carbonero R, Sorbye H, Baudin E, Raymond E, Wiedenmann B, Niederle B, Sedlackova E, Toumpanakis C, Anlauf M, Cwikla JB, Caplin M, O’Toole D, Perren A, Vienna Consensus Conference participants. ENETS Consensus Guidelines for High-Grade Gastroenteropancreatic Neuroendocrine Tumors and Neuroendocrine Carcinomas. 2016; 103(2): 186-94. PubMed
  7. Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment (PDQ) – Health Professional Version. National Cancer Institute. [Updated: Feb 2018; Accessed: Aug 2018]
  8. Oberg K, Couvelard A, Fave GD, Gross D, Grossman A, Jensen RT, Pape U, Perren A, Rindi G, Ruszniewski P, Scoazec J, Welin S, Wiedenmann B, Ferone D, all other Antibes Consensus Conference participants. ENETS Consensus Guidelines for Standard of Care in Neuroendocrine Tumours: Biochemical Markers. 2017; PubMed
  9. Falconi M, Eriksson B, Kaltsas G, Bartsch DK, Capdevila J, Caplin M, Kos-Kudla B, Kwekkeboom D, Rindi G, Klöppel G, Reed N, Kianmanesh R, Jensen RT, Vienna Consensus Conference participants. ENETS Consensus Guidelines Update for the Management of Patients with Functional Pancreatic Neuroendocrine Tumors and Non-Functional Pancreatic Neuroendocrine Tumors. 2016; 103(2): 153-71. PubMed

 

Definition:

Insulinomas are the most common functional pancreatic neuroendocrine tumors (PNETs). They result from growth of islet cells that produce excess insulin. Insulinomas may be associated with multiple endocrine neoplasia 1 (MEN1) or Wermer syndrome. Only 10% of insulinomas are malignant.

Panel test:

  • Proinsulin, Intact/ Insulin Ratio
  • C-Peptide (serum, plasma)

 

References

Guidelines

  1. Oberg K, Couvelard A, Fave GD, Gross D, Grossman A, Jensen RT, Pape U, Perren A, Rindi G, Ruszniewski P, Scoazec J, Welin S, Wiedenmann B, Ferone D, all other Antibes Consensus Conference participants. ENETS Consensus Guidelines for Standard of Care in Neuroendocrine Tumours: Biochemical Markers. 2017; PubMed
  2. Perren A, Couvelard A, Scoazec J, Costa F, Borbath I, Fave GD, Gorbounova V, Gross D, Grossma A, Jense RT, Kulke M, Oeberg K, Rindi G, Sorbye H, Welin S, Antibes Consensus Conference participants. ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: Pathology: Diagnosis and Prognostic Stratification. 2017; 105(3): 196-200. PubMed
  4. NCCN Clinical Practice Guidelines in Oncology, Neuroendocrine and Adrenal Tumors. Version 2.2018. NCCN Clinical Practice Guidelines in Oncology, Neuroendocrine and Adrenal Tumors. Version 2.2018.. Fort Washington, PA [Updated: May 2018; Accessed: May 2018]
  5. Falconi M, Eriksson B, Kaltsas G, Bartsch DK, Capdevila J, Caplin M, Kos-Kudla B, Kwekkeboom D, Rindi G, Klöppel G, Reed N, Kianmanesh R, Jensen RT, Vienna Consensus Conference participants. ENETS Consensus Guidelines Update for the Management of Patients with Functional Pancreatic Neuroendocrine Tumors and Non-Functional Pancreatic Neuroendocrine Tumors. 2016; 103(2): 153-71. PubMed
  6. Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment (PDQ) – Health Professional Version. National Cancer Institute. [Updated: Feb 2018; Accessed: Aug 2018]
  7. O’Toole D, Kianmanesh R, Caplin M. ENETS 2016 Consensus Guidelines for the Management of Patients with Digestive Neuroendocrine Tumors: An Update. 2016; 103(2): 117-8. PubMed

 

 

Definition:

Carcinoid tumors are rare, slow-growing tumors. Some may be functional neuroendocrine tumors (NETs) of the gastrointestinal system, lungs, or thymus and release hormones or vasoactive substances. These factors cause clinical syndromes characterized by flushing and diarrhea (gastrointestinal) or wheezing and right heart effects (bronchopulmonary). Carcinoid syndromes usually do not occur until tumors metastasize to the liver.

 

Panel test:

  • Chromogranin A (Immunohistochemistry, EIA)
  • Gastrin (Immunohistochemistry, Quantitative chemiluminescent Immunoassay)
  • Neurokinin A (Plasma)
  • Synaptophysin
  • Cytokeratin 8, 18 Low molecular weight (CAM 5.2)
  • Neuron Specific Enolase, Plyclonal (NSEP)
  • K1-67, MIB-1
  • Thyroid Transcription Factor (TTF-1)
  • CDX2
  • PAX8

 

References

Guidelines

  1. Gastrointestinal Carcinoid Tumors Treatment (PDQ®)–Health Professional Version. National Cancer Institute. Bethesda, MD [Updated: Feb 2018; Accessed: Mar 2018]
  2. Protocol for the Examination of Specimens from Patients with Neuroendocrine Tumors (Carcinoid Tumors) of the Appendix. Based on AJCC/UICC TNM, 7th ed. Protocol web posting date: Jan 2016. College of American Pathologists (CAP) . Northfield, IL [Revised : Oct 2013; Accessed: Mar 2018]
  3. Protocol for the Examination of Specimens from Patients with Primary Carcinoma of the Colon and Rectum. Based on AJCC/UICC TNM, 7th ed. Protocol web posting date: Oct 2013. College of American Pathologists (CAP). Northfield, IL [Revised: Jan 2016; Accessed: Mar 2018]
  4. Protocol for the Examination of Specimens from Patients with Neuroendocrine Tumors (Carcinoid Tumors) of the Small Intestine and Ampulla. Based on AJCC/UICC TNM, 7th ed. Protocol web posting date: Oct 2013. College of American Pathologists (CAP). Northfield, IL [Revised: Oct 2013; Accessed: Mar 2018]
  5. Protocol for the Examination of Specimens from Patients with Neuroendocrine Tumors (Carcinoid Tumors) of the Stomach. Based on AJCC/UICC TNM, 7th ed. Protocol web posting date: Oct 2013. College of American Pathologists (CAP). Northfield, IL [Revised: Jun 2014; Accessed: Mar 2018]
  6. Fave D, O’Toole D, Sundin A, Taal B, Ferolla P, Ramage JK, Ferone D, Ito T, Weber W, Zheng-Pei Z, De Herder WW, Pascher A, Ruszniewski P, Vienna Consensus Conference participants. ENETS Consensus Guidelines Update for Gastroduodenal Neuroendocrine Neoplasms. 2016; 103(2): 119-24. PubMed
  7. Garcia-Carbonero R, Sorbye H, Baudin E, Raymond E, Wiedenmann B, Niederle B, Sedlackova E, Toumpanakis C, Anlauf M, Cwikla JB, Caplin M, O’Toole D, Perren A, Vienna Consensus Conference participants. ENETS Consensus Guidelines for High-Grade Gastroenteropancreatic Neuroendocrine Tumors and Neuroendocrine Carcinomas. 2016; 103(2): 186-94. PubMed
  8. NCCN Clinical Practice Guidelines in Oncology, Neuroendocrine and Adrenal Tumors. Version 4.2018. National Comprehensive Cancer Network. Fort Washington, PA [Updated: May 2018; Accessed: Jul 2018]
  9. Niederle B, Pape U, Costa F, Gross D, Kelestimur F, Knigge U, Öberg K, Pavel M, Perren A, Toumpanakis C, O’Connor J, O’Toole D, Krenning E, Reed N, Kianmanesh R, Vienna Consensus Conference participants. ENETS Consensus Guidelines Update for Neuroendocrine Neoplasms of the Jejunum and Ileum. 2016; 103(2): 125-38. PubMed
  10. Oberg K, Knigge U, Kwekkeboom D, Perren A, ESMO Guidelines Working Group. Neuroendocrine gastro-entero-pancreatic tumors: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.Ann Oncol. 2012; 23 Suppl 7: vii124-30. PubMed
  11. Pape U, Niederle B, Costa F, Gross D, Kelestimur F, Kianmanesh R, Knigge U, Öberg K, Pavel M, Perren A, Toumpanakis C, O’Connor J, Krenning E, Reed N, O’Toole D, Vienna Consensus Conference participants. ENETS Consensus Guidelines for Neuroendocrine Neoplasms of the Appendix (Excluding Goblet Cell Carcinomas). 2016; 103(2): 144-52. PubMed
  12. Ramage JK, De Herder WW, Fave D, Ferolla P, Ferone D, Ito T, Ruszniewski P, Sundin A, Weber W, Zheng-Pei Z, Taal B, Pascher A, Vienna Consensus Conference participants. ENETS Consensus Guidelines Update for Colorectal Neuroendocrine Neoplasms. 2016; 103(2): 139-43. PubMed
  13. Kunz PL, Reidy-Lagunes D, Anthony LB, Bertino EM, Brendtro K, Chan JA, Chen H, Jensen RT, Kim MK, Klimstra DS, Kulke MH, Liu EH, Metz DC, Phan AT, Sippel RS, Strosberg JR, Yao JC, North American Neuroendocrine Tumor Society. Consensus guidelines for the management and treatment of neuroendocrine tumors. 2013; 42(4): 557-77. PubMed

 

 

Definition:

Somatostatinomas are rare, functional neuroendocrine tumors (NETs) that produce excessive amounts of somatostatin. Somatostatin inhibits cholecystokinin, insulin, and pancreatic exocrine function. Tumors are usually malignant with metastases at diagnosis.

 

Panel test:

  • Chromogranin A (Immunohistochemistry)
  • Somatostatin (Plasma)
  • Synaptophysin
  • Pan Cytokeratin (AE1,3)
  • Ki-67
  • Neuron Specific Enalase, Polyclonal (NSEP)

 

References

Guidelines

  1. Protocol for the Examination of Specimens from Patients with Tumors of the Endocrine Pancreas. Based on AJCC/UICC TNM, 7th ed. Protocol web posting date: Aug 2016. College of American Pathologists (CAP). Northfield, IL [Revised: Aug 2016; Accessed: July 2018]
  2. Protocol for the Examination of Specimens from Patients with Neuroendocrine Tumors (Carcinoid Tumors) of the Small Intestine and Ampulla. Based on AJCC/UICC TNM, 7th ed. Protocol web posting date: Oct 2013. College of American Pathologists (CAP). Northfield, IL [Revised: Oct 2013; Accessed: Mar 2018]
  3. Protocol for the Examination of Specimens from Patients with Neuroendocrine Tumors (Carcinoid Tumors) of the Stomach. Based on AJCC/UICC TNM, 7th ed. Protocol web posting date: Oct 2013. College of American Pathologists (CAP). Northfield, IL [Revised: Jun 2014; Accessed: Mar 2018]
  4. NCCN Clinical Practice Guidelines in Oncology, Neuroendocrine and Adrenal Tumors. Version 4.2018. National Comprehensive Cancer Network. Fort Washington, PA [Updated: May 2018; Accessed: Jul 2018]
  5. Oberg K, Couvelard A, Fave GD, Gross D, Grossman A, Jensen RT, Pape U, Perren A, Rindi G, Ruszniewski P, Scoazec J, Welin S, Wiedenmann B, Ferone D, all other Antibes Consensus Conference participants. ENETS Consensus Guidelines for Standard of Care in Neuroendocrine Tumours: Biochemical Markers. Neuroendocrinology. 2017; PubMed
  6. Falconi M, Eriksson B, Kaltsas G, Bartsch DK, Capdevila J, Caplin M, Kos-Kudla B, Kwekkeboom D, Rindi G, Klöppel G, Reed N, Kianmanesh R, Jensen RT, Vienna Consensus Conference participants. ENETS Consensus Guidelines Update for the Management of Patients with Functional Pancreatic Neuroendocrine Tumors and Non-Functional Pancreatic Neuroendocrine Tumors. Neuroendocrinology. 2016; 103(2): 153-71. PubMed
  7. Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment (PDQ) – Health Professional Version. National Cancer Institute. [Updated: Feb 2018; Accessed: Aug 2018]

 

 

Definition:

Vasoactive intestinal polypeptide secreting tumors (VIPomas) are very rare pancreatic neuroendocrine tumors (PNETs) associated with profuse diarrhea. They are usually single tumors and metastatic at diagnosis. Generally, laboratory testing includes an electrolyte panel and vasoactive intestinal peptide test.

Panel test:

  • Chromogranin A (Immunohistochemistry, Quantitative EIA)
  • Gastrin (Immunohistochemistry, Quantitative chemiluminescent Immunoassay)
  • Synaptophysin
  • Neuron Specific Enolase, Plyclonal (NSEP)
  • Ki-67, MIB-1

 

References

Guidelines

  1. NCCN Clinical Practice Guidelines in Oncology, Neuroendocrine and Adrenal Tumors. Version 4.2018. National Comprehensive Cancer Network. Fort Washington, PA [Updated: May 2018; Accessed: Jul 2018]
  2. Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment (PDQ) – Health Professional Version. National Cancer Institute. [Updated: Feb 2018; Accessed: Aug 2018]
  3. Oberg K, Couvelard A, Fave GD, Gross D, Grossman A, Jensen RT, Pape U, Perren A, Rindi G, Ruszniewski P, Scoazec J, Welin S, Wiedenmann B, Ferone D, all other Antibes Consensus Conference participants. ENETS Consensus Guidelines for Standard of Care in Neuroendocrine Tumours: Biochemical Markers. 2017; PubMed
  4. Falconi M, Eriksson B, Kaltsas G, Bartsch DK, Capdevila J, Caplin M, Kos-Kudla B, Kwekkeboom D, Rindi G, Klöppel G, Reed N, Kianmanesh R, Jensen RT, Vienna Consensus Conference participants. ENETS Consensus Guidelines Update for the Management of Patients with Functional Pancreatic Neuroendocrine Tumors and Non-Functional Pancreatic Neuroendocrine Tumors. 2016; 103(2): 153-71. PubMed

 

 

 

Definition:

Acute pancreatitis is a reversible inflammatory process of the pancreas that may be associated with a systemic inflammatory response that can cause multiorgan impairment. Lipase testing should be ordered instead of amylase for diagnosis.

Panel test:

  • C-Reactive protein
  • Procalcitonin
  • Trypsin

References

Guidelines

  1. Choosing Wisely. An initiative of the ABIM Foundation. [Accessed: Apr 2019]
  2. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS, Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. 2013; 62(1): 102-11. PubMed
  3. Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. 2013; 13(4 Suppl 2): e1-15. PubMed

 

Definition:

Autoimmune pancreatitis (AIP) is a rare form of chronic pancreatitis characterized by diffuse enlargement of the pancreas, narrowing of the pancreatic duct, and lymphoplasmacytic infiltration and fibrosis. AIP presents similarly to pancreatic cancer, so definite diagnosis is imperative to avoid unnecessary major surgery.

Type I AIP is the pancreatic manifestation of systemic IgG4-related disease. Histologically, it is a lymphoplasmacytic sclerosing pancreatitis (LPSP). Type 2 AIP, or idiopathic duct-centric pancreatitis, is IgG4 negative and is characterized by granulocytic lesions. Type 2 is more rare and less well understood.

Both types respond to steroid therapy, although type 1 AIP will often (20-60% of the time) relapse (Hart, 2015).

 

Panel test:

  • Immunoglobulin G subclass 4
  • Canser antigen –GI (CA-19-9)
  • IgG4 (Immunohistochemistry)

 

References

Guidelines

  1. Shimosegawa T, Chari ST, Frulloni L, Kamisawa T, Kawa S, Mino-Kenudson M, Kim MH, Klöppel G, Lerch MM, Löhr M, Notohara K, Okazaki K, Schneider A, Zhang L; International Association of Pancreatology. International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology. Pancreas. 2011 Apr;40(3):352-8. PubMed

General References

  1. Martins C, Lago P, Sousa P, Araújo T, Davide J, Castro-Poças F, Pedroto I. Type 2 Autoimmune Pancreatitis: A Challenge in the Differential Diagnosis of a Pancreatic Mass.GE Port J Gastroenterol. 2017; 24(6): 296-300. PubMed
  2. Stone JH, Brito-Zerón P, Bosch X, Ramos-Casals M. Diagnostic Approach to the Complexity of IgG4-Related Disease.Mayo Clin Proc. 2015; 90(7): 927-39. PubMed
  3. Matsubayashi H, Kakushima N, Takizawa K, Tanaka M, Imai K, Hotta K, Ono H. Diagnosis of autoimmune pancreatitis.World J Gastroenterol. 2014; 20(44): 16559-69. PubMed

 

Definition:

Chronic pancreatitis includes a number of progressive inflammatory diseases, such as calcifying, chronic obstructive, and steroid-responsive or autoimmune chronic pancreatitis, which lead to pancreatic damage. At its later stages, chronic pancreatitis can result in pancreatic exocrine and endocrine insufficiency and diabetes. Treatment does not stop disease progression; it serves only to relieve pain and address complications. The pathogenesis of chronic pancreatitis is not fully understood, but episodes of acute pancreatitis are associated with the development of chronic pancreatitis. Alcohol use, smoking, and genetic factors also influence risk.  Although late-state chronic pancreatitis may be obvious, early-stage chronic pancreatitis presents a diagnostic challenge because pancreatic function may not yet be compromised, and the pancreas might appear normal on imaging. Definitive diagnosis requires a combination of diagnostic tools, such as clinical examination, imaging, endoscopic procedures, and laboratory tests of pancreatic function.

 

Panel test:

  • Pancreatic Elastase
  • Trypsin

 

References

  1. Majumder S, Chari ST. Chronic pancreatitis. 2016; 387(10031): 1957-66. PubMed
  2. Gupte A, Goede D, Tuite R, Forsmark CE. Chronic pancreatitis. 2018; 361: k2126. PubMed
  3. Anaizi A, Hart PA, Conwell DL. Diagnosing Chronic Pancreatitis.Dig Dis Sci. 2017; 62(7): 1713-1720. PubMed
  4. Capurso G, Traini M, Piciucchi M, Signoretti M, Arcidiacono PG. Exocrine pancreatic insufficiency: prevalence, diagnosis, and management.Clin Exp Gastroenterol. 2019; 12: 129-139. PubMed
  5. McPherson RA, Pincus MR, eds. Henry’s Clinical Diagnosis and Management by Laboratory Methods, 23rd ed. St. Louis, MO: Elsevier, 2017.

 

Definition:

Diabetes mellitus (DM) is a group of metabolic disorders characterized by hyperglycemia that results from defects in insulin secretion, insulin action, or both. DM can be classified as type 1 (characterized by insulin deficiency), the more common type 2 (characterized by insulin resistance with relative insulin deficiency), gestational diabetes mellitus (GDM) (a condition that occurs only during pregnancy), and other less common conditions (eg, monogenic DM). Laboratory evaluations used to screen for, diagnose, and monitor DM include a fasting plasma glucose (FPG) test, a hemoglobin A1c (A1c) test, and an oral glucose tolerance test (OGTT). Those diagnosed with DM or GDM require regular laboratory evaluation to assist in glycemic management and to monitor for the development of diabetes-related complications.

Panel test:

  • Glutamic Acid Decarboxylase antibody
  • Insulin Antibody
  • Islet Antigen-2 (IA-2) autoantibody (Serurm)
  • Islet cell cytoplasmic antibody, IgG
  • Zinc Transporter 8 antibody

 

References

  1. Handelsman Y, Bloomgarden ZT, Grunberger G, Umpierrez G, Zimmerman RS, Bailey TS, Blonde L, Bray GA, Cohen J, Dagogo-Jack S, Davidson JA, Einhorn D, Ganda OP, Garber AJ, Garvey T, Henry RR, Hirsch IB, Horton ES, Hurley DL, Jellinger PS, Jovanovič L, Lebovitz HE, LeRoith D, Levy P, McGill JB, Mechanick JI, Mestman JH, Moghissi ES, Orzeck EA, Pessah-Pollack R, Rosenblit PD, Vinik AI, Wyne K, Zangeneh F. American Association of Clinical Endocrinologists and American College of Endocrinology – Clinical practice guidelines for developing a diabetes mellitus comprehensive care plan – 2015.Endocr Pract. 2015; 21 Suppl 1: 1-87. PubMed
  2. American Diabetes Association. Standards of Medical Care in Diabetes—2019. Arlington County, VA [Accessed: Apr 2019]
  3. Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus.Obstet Gynecol. 2018; 131(2): e49-e64. PubMed
  4. Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycemia. World Health Organization. Geneva, Switzerland [Accessed: Apr 2019]

 

 

Definition:

Symptomatic hypoglycemia that is corrected with the administration of glucose is characteristic of hyperinsulinemic hypoglycemia. The cause should be investigated so that underlying conditions can be corrected. Hypoglycemia may constitute a medical emergency, as it can result in permanent neurologic defects or death. Patient history (eg, diabetes, drug history) should guide the investigation. Laboratory testing includes plasma glucose, insulin, proinsulin, insulin antibodies, C-peptide, beta-hydroxybutyrate, fatty acids, and therapeutic drug testing. A classic lab finding is hypoketotic hypo-fatty-acidemic hypoglycemia.

 

Panel test:

o   C-Peptide (serum, plasma)

  • Proinsulin, Intact
  • Cortisol (serum)
  • Insulin Antibody

References

Guidelines

  1. Thornton PS, Stanley CA, De León DD, Harris D, Haymond MW, Hussain K, Levitsky LL, Murad MH, Rozance PJ, Simmons RA, Sperling MA, Weinstein DA, White NH, Wolfsdorf JI, Pediatric Endocrine Society. Recommendations from the Pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants, and Children.J Pediatr. 2015; 167(2): 238-45. PubMed
  2. Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER, Service J, Endocrine Society. Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline.J Clin Endocrinol Metab. 2009; 94(3): 709-28. PubMed

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