2022 Volume 65 Issue 12 Pages 651-657
We herein report an elderly patient on hemodialysis with persistent symptomatic hypoglycemia due to insulinoma. A 91-year-old woman without a history of diabetes mellitus was receiving hemodialysis. Since she demonstrated delirium and unconsciousness with a blood glucose level of <58 mg/dL, she required continuous infusion of glucose to avoid symptomatic hypoglycemia; however, due to the limited volume of liquid administration available for hemodialysis, high-calorie infusion was administered via a central venous port. Blood sampling during the hypoglycemic attacks revealed a blood glucose level of 5 mg/dL, serum insulin (IRI) level of 267 μU/mL, and serum C peptide level of 60.5 ng/mL, indicating hyperinsulinemic hypoglycemia. Insulioma was suspected as a differential diagnosis, but computed tomography did not detect hypervascular tumors in the pancreas. Selective arterial calcium injection (SACI) was not performed due to her age and dialysis status. Diazoxide was orally administered at treatment, and diazoxide at 100 mg in the morning and 150 mg in the evening on the day of hemodialysis ultimately resulted in the time in range (56 through 158 mg/dL) of her blood glucose level being 98 %, estimated flash glucose monitoring. The present case highlights the clinical utility of diazoxide for treating persistent hypoglycemia due to insulinoma with no indication of operation; however, dose titration is needed for patients on hemodialysis.
