Increased plasma β-hydroxybutyrate levels during the fasting test in patients with endogenous hyperinsulinaemic hypoglycaemia

Eur J Endocrinol. 2013 Jun 7;169(1):91-7. doi: 10.1530/EJE-13-0020. Print 2013 Jul.

Abstract

Objective: The objective of the present study was to determine whether a plasma β-hydroxybutyrate (BOHB) level >2700 μmol/l during the 72-h fasting test is sufficient to rule out the diagnosis of endogenous hyperinsulinaemic hypoglycaemia (EHH).

Research design and methods: We retrospectively studied BOHB levels in 39 patients with EHH who had undergone a 72-H fasting test to make the diagnosis of EHH, and we compared EHH patients with BOHB levels 2700 MOL/L (group 1), EHH PATIENTS with BOHB levels 2700 MOL/L (group 2) and 59 controls (median glycaemia: 3.2 mmol/l and median BOHB: 6095 μmol/l).

Results: During a 72-h fasting test, nine patients (group 1) had BOHB levels >2700 μmol/l (median 6140 and range 2957-7824) and 30 patients (group 2) had BOHB levels <2700 μmol/l (median 542 and range 0-2607). In group 1, four patients had undergone partial pancreatectomy previously and were evaluated for the recurrence of hypoglycaemia, whereas none of the group 2 patients had been operated. The duration of the fasting test was longer in group 1 than in group 2 (P<0.0001), and at the end of the fasting test, plasma glucose concentrations were not significantly different (P=0.0617), but insulin (P=0.004), C-peptide (P=0.0015) and proinsulin (P=0.0038) levels were significantly lower in group 1 patients than in group 2 patients, suggesting lower insulin secretion and/or impaired glycaemic counter-regulation.

Conclusion: During a fasting test, a BOHB level >2700 μmol/l is observed in some EHH patients, suggesting that BOHB levels cannot rule out the recurrence of EHH, in particular, after partial pancreatectomy.

MeSH terms

  • 3-Hydroxybutyric Acid / blood*
  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Blood Glucose / metabolism
  • C-Peptide / blood
  • Diagnosis, Differential
  • Fasting / blood*
  • Female
  • Humans
  • Hyperinsulinism / blood
  • Hyperinsulinism / diagnosis*
  • Hyperinsulinism / etiology
  • Hyperinsulinism / prevention & control
  • Hypoglycemia / blood
  • Hypoglycemia / diagnosis*
  • Hypoglycemia / etiology
  • Hypoglycemia / prevention & control
  • Insulinoma / blood*
  • Insulinoma / complications
  • Insulinoma / surgery
  • Male
  • Middle Aged
  • Multiple Endocrine Neoplasia Type 1 / blood
  • Pancreatectomy* / methods
  • Pancreatic Neoplasms / blood*
  • Pancreatic Neoplasms / complications
  • Pancreatic Neoplasms / surgery
  • Predictive Value of Tests
  • Reproducibility of Results
  • Retrospective Studies
  • Sensitivity and Specificity
  • Time Factors
  • Treatment Outcome

Substances

  • Biomarkers
  • Blood Glucose
  • C-Peptide
  • 3-Hydroxybutyric Acid