Journal of Clinical Endocrinology & Metabolism, Vol 79, 1428-1433, Copyright © 1994 by Endocrine Society
Suspected postprandial hypoglycemia is associated with beta-adrenergic hypersensitivity and emotional distress
I Berlin, A Grimaldi, C Landault, F Cesselin and AJ Puech
Departement de Pharmacologie Clinique, Hopital Pitie-Salpetriere, Paris, France.
Suspected postprandial (reactive or idiopathic) hypoglycemia is
characterized by predominantly adrenergic symptoms appearing after meals
rich in carbohydrates and by their rare association with low blood glucose
level (< 2.77 mmol/L). We studied heart rate, blood pressure, plasma
insulin, C-peptide, and catecholamine responses during a 5-h oral glucose
tolerance test in eight patients with suspected postprandial hypoglycemia
and eight age-, sex-, and body mass index- matched healthy controls. We
also evaluated beta-adrenergic sensitivity by using the isoproterenol
sensitivity test. Psychological profile was assessed by the Symptom
Checklist (SCL-90R) self-report symptom inventory. Patients with suspected
postprandial hypoglycemia had higher beta-adrenergic sensitivity (defined
as the dose of isoproterenol required to increase the resting heart rate by
25 beats/min) than controls (mean +/- SEM, 0.8 +/- 0.13 vs. 1.86 +/- 0.25
microgram isoproterenol; P = 0.002). After administration of glucose (75 g)
blood glucose, plasma C-peptide, plasma epinephrine, and plasma
norepinephrine responses were identical in the two groups, but plasma
insulin was higher in the patients (group effect, P = 0.02; group by time
interaction, P = 0.0001). Both heart rate and systolic blood pressure were
significantly higher (but remained in the normal range) after glucose
administration in patients with suspected postprandial hypoglycemia than in
controls (group by time interactions, P = 0.004 and 0.0007, respectively).
After glucose intake, seven patients had symptoms (palpitations, headache,
tremor, generalized sweating, hunger, dizziness, sweating of the palms,
flush, nausea, and fatigue), whereas in the control group, one subject
reported flush and another palpitations, tremor, and hunger. Analysis of
the SCL-90R questionnaire revealed that patients had emotional distress and
significantly higher anxiety, somatization, depression, and
obsessive-compulsive scores than controls. We may conclude that patients
with suspected postprandial hypoglycemia have normal glucose tolerance,
increased beta-adrenergic sensitivity, and emotional distress.
