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Bonsoir a tous..

Comme promis boss.. :|

1. A 23-year-old female nursing student is brought to the emergency room by her parents after being found unconscious at home. She is noted to have a fingerstick glucose of 29 mg/dL. After administration of intravenous D50, she rapidly regains consciousness. Her parents state that this is the fourth time in a month that this has occurred. She is not taking any medications. The medical history is unremarkable except for a history of depression and a mother with diabetes mellitus. Examination is unremarkable. During an observed period in the hospital, the patient is noted to have a symptomatic glucose level of 31 mg/dL. Plasma insulin levels are elevated, and C-peptide levels are low. Which of the following is the most likely cause of her hypoglycemia?


Choose the one best response to this question.

A. Glipizide overdose
B. Surreptitious insulin use
C. Insulinoma
D. Glucagonoma
E. Diabetic ketoacidosis


Diabetic ketoacidosis = acidocétose diabetique
Insulinoma = Insulinome
Glucagonoma = Glucagonome
Hypoglycemia = Hypoglycémie
unconscious = inconsciente
fingerstick glucose = glycémie capillaire
D50 = Sérum Glucosé 5% (Dextrose 50).
Medical history = ATCD médicaux
Diabetes mellitus = Diabète sucré



Answer:
The answer is B.
>>> Factitious hypoglycemia from self-administration of insulin or ingestion of a sulfonylurea shares clinical and laboratory features with insulinoma. The absence of an elevated C peptide distinguishes exogenous insulin use from insulinoma. An undetectable sulfonylurea level works against a diagnosis of sulfonylurea toxicity. Factitious hypoglycemia is more common in health care workers, patients with diabetes and their relatives, and patients with psychiatric histories