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Deficient Counterregulatory Hormone Responses during Hypoglycemia in a Patient with Insulinoma^*

Department of Medicine, Division of Endocrinology, Albert Einstein College of Medicine Bronx, New York 10461

Address all correspondence and requests for reprints to: Dr. Maris R. Davis, Department of Medicine, Division of Endocrinology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, New York 10461.

Counterregulatory hormone responses were evaluated in a 37-yr-old woman before and after removal of a benign insulin-producing islet cell tumor. Counterregulatory hormone concentrations were measured during a glucose clamp with graded reductions of plasma glucose from 5.2 to 2.6 mmol/L. In the study before surgery, the increase in plasma epinephrine concentration was markedly blunted (by >90%) compared to that in the study after surgery. The peak plasma norepinephrine concentration was similarly reduced by 71%, and plasma cortisol by 63%. In addition, the glycemic thresholds for secretion of the counterregulatory hormones were lower before removal of the tumor. Peak plasma GH responses were equivalent before and after surgery, but the threshold for GH secretion was 21% lower in the first hypoglycemia study. We conclude 1) that there is evidence for abnormal glucose counterregulatory hormone secretion in this patient, which may contribute to the pathogenesis of hypoglycemia seen in patients with insulinoma; 2) the reversal of reduced counterregulatory hormone secretion after tumor resection suggests that these defective hormonal responses may be related to recurrent hypoglycemia, persistent hyperinsulinemia, or both; and 3) that abnormal glucose counterregulation may exist in the absence of type 1 diabetes. (J Clin Endocrinol Metab 72: 788–792, 1991)

^* This work was supported in part by NIH Grants ROl-DK-36617 and DK-20541, and a Fellowship Grant from the Juvenile Diabetes Foundation International.

Received July 30, 1990.

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