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  #1  
Old 10-17-2011
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GIT Fainting after eating!

A 34-year-old woman is brought to the emergency department because of an episode of convulsions and coma that occurred about 45 minutes after she ate a very large meal. On arrival, she is sweating profusely and barely waking up from her stuporous state. Blood is drawn for laboratory studies and she is taken to the CT scanner for a CT of her head. The CT is completely normal. When the laboratory studies come back they show her blood sugar to be 45 mg/dL. Insulin and C-peptide determinations are then requested, which eventually come back showing significant elevations. After these finding, she is questioned further and gives a history that for many years she has felt faint after she eats. She describes episodes where she has palpitations, sweating, weakness, and tremors, always half an hour to an hour and a half after she eats. If she skips meals for any reason, the symptoms do not occur. Which of the following is the most appropriate next step in management?

A. CT scan of the pancreas
B. Psychiatric consultation
C. Suitable dietary modifications
D. 24-hour urinary collection for catecholamines
E. 24-hour urinary collection for 5-hydroxy-indolacetic acid
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  #2  
Old 10-17-2011
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E. 24-hour urinary collection for 5-hydroxy-indolacetic acid
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  #3  
Old 10-17-2011
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Default insulinoma

i think this is insulinoma so id go with A
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Old 10-17-2011
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Quote:
Originally Posted by meka View Post
i think this is insulinoma so id go with A
i do agree with you it's
A. CT scan of the pancreas
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Old 10-17-2011
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is it insulinomas produce insulin only after meals???? pt says if she skips the meals she will be alright ???? can any one explain this one
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Old 10-17-2011
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Quote:
Originally Posted by mazrodin View Post
is it insulinomas produce insulin only after meals???? pt says if she skips the meals she will be alright ???? can any one explain this one

i think, when she eats .. high glucose level stimulate high insluin level and lead to hypoglycemia and when she doesn't eat ..she's alright ?
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Old 10-17-2011
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Smile Answer

The correct answer is C. The clinical picture here is classic for reactive hypoglycemia, which follows food ingestion. Smaller and more frequent meals will ameliorate the problem.
CT scan of the pancreas (choice A) would be appropriate if we suspected an insulinoma, but such lesions invariably produce symptoms during fasting, and not after meals.
Psychiatric consultation (choice B) would have been in order if we suspected self-administration of insulin. But in that case, the C-peptide would have been low at the same time that the insulin levels were high.
Catecholamines are indeed responsible for the sweating and palpitations that she reports, but these are normal reactions to the hypoglycemia. Determining levels in the urine (choice D) will not advance the diagnosis or therapy.
5-Hydroxy-indolacetic acid (choice E) is the marker for the carcinoid syndrome. Hypoglycemia is not part of that disease. The attacks in the carcinoid syndrome are due to circulating serotonin, and the classic findings are flushing, itching, and diarrhea.
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  #8  
Old 10-22-2011
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its dumping syndrome. (C)
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