Advertisement
Mayo Clinic Proceedings Home

81-Year-Old Man With Episodic Spells of Weakness, Fatigue, and “Shakes”

Published:November 03, 2022DOI:https://doi.org/10.1016/j.mayocp.2022.05.023
      An 81-year-old Mediterranean man presented to the emergency department with 6 months of episodic nervousness, warmth, sweating, and hunger that would subsequently progress to weakness, fatigue, difficulty concentrating, and “feeling shaky.” He denied loss of consciousness, dizziness, palpitations, chest pain, dyspnea, and post-event weakness. Symptoms occurred throughout the day and night and resolved by consuming snacks or juice. The patient thus consumed frequent scheduled meals throughout the day and night. He lived alone, but symptoms had been observed and confirmed by nearby family members. He was otherwise healthy and denied alcohol or drug use. His only medication was atorvastatin, and he denied use of any over-the-counter supplements or difficulty taking his medication. He had no known significant medical history aside from resection of a benign lung mass 30 years earlier. He denied other surgical history, including weight-loss surgeries. He denied personal or family history of cancer, diabetes, or endocrine disorders.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Professional Practice Committee American Diabetes Association
        7. Diabetes technology: standards of medical care in diabetes–2022.
        Diabetes Care. 2022; 45: S97-S112
        • Douillard C.
        • Jannin A.
        • Vantyghem M.C.
        Rare causes of hypoglycemia in adults.
        Ann Endocrinol (Paris). 2020; 81: 110-117
        • Hirshberg B.
        • Livi A.
        • Bartlett D.L.
        • et al.
        Forty-eight-hour fast: the diagnostic test for insulinoma.
        J Clin Endocrinol Metab. 2000; 85: 3222-3226https://doi.org/10.1210/jcem.85.9.6807
        • Mathur A.
        • Gorden P.
        • Libutti S.K.
        Insulinoma.
        Surg Clin North Am. 2009; 89: 1105-1121
        • Okabayashi T.
        • Shima Y.
        • Sumiyoshi T.
        • et al.
        Diagnosis and management of insulinoma.
        World J Gastroenterol. 2013; 19: 829-837
        • Nockel P.
        • Babic B.
        • Millo C.
        • et al.
        Localization of Insulinoma Using 68Ga-DOTATATE PET/CT Scan.
        J Clin Endocrinol Metab. 2017; 102: 195-199
        • Matej A.
        • Bujwid H.
        • Wroński J.
        Glycemic control in patients with insulinoma.
        Hormones (Athens). 2016; 15: 489-499
        • Cryer P.E.
        • Axelrod L.
        • Grossman A.B.
        • et al.
        Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline.
        J Clin Endocrinol Metab. 2009; 94: 709-728
        • Shin J.J.
        • Gorden P.
        • Libutti S.K.
        Insulinoma: pathophysiology, localization and management.
        Future Oncol. 2010; 6: 229-237
        • Kandaswamy L.
        • Raghavan R.
        • Pappachan J.M.
        Spontaneous hypoglycemia: diagnostic evaluation and management.
        Endocrine. 2016; 53: 47-57
        • Thompson S.M.
        • Vella A.
        • Thompson G.B.
        • et al.
        selective arterial calcium stimulation with hepatic venous sampling differentiates insulinoma from nesidioblastosis.
        J Clin Endocrinol Metab. 2015; 100: 4189-4197
      CORRECT ANSWERS: 1. e. 2. c. 3. e. 4. c. 5. d.