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

Published:November 03, 2022DOI:
      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.
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      CORRECT ANSWERS: 1. e. 2. c. 3. e. 4. c. 5. d.