{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,3,8]],"date-time":"2024-03-08T07:01:24Z","timestamp":1709881284640},"reference-count":15,"publisher":"Georg Thieme Verlag KG","issue":"19","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dtsch Med Wochenschr"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>\n          Anamnese\u2002Die Vorstellung einer 59-j\u00e4hrigen Frau erfolgte zur endokrinologischen Abkl\u00e4rung rezidivierender Spontanhypoglyk\u00e4mien. Die Beschwerden waren stets nach Kohlenhydrataufnahme regredient. Aufgrund eines klassischen adrenogenitalen Syndroms erhielt die Patientin seit jungen Jahren eine Substitutionstherapie mit Hydrocortison.<\/jats:p><jats:p>\n          Untersuchung\u2002Die Patientin pr\u00e4sentierte sich in einem altersentsprechenden Allgemein- und leicht \u00fcbergewichtigen Ern\u00e4hrungszustand. Der Blutzucker lag zum Aufnahmezeitpunkt bei 87\u200amg\/dl. Weiterhin konnten unter Substitution mit retardiertem Hydrocortison ein unauff\u00e4lliges Cortisol sowie adrenokortikotropes Hormon (ACTH) nachgewiesen werden. Im Mixed-Meal-Tolerance-Test (MMTT, standardisierter Fr\u00fchst\u00fcckstest) zeigte sich keine reaktive Hypoglyk\u00e4mie. Im anschlie\u00dfenden 72-Stunden-Hungerversuch trat nach 36 Stunden eine symptomatische Hypoglyk\u00e4mie auf. Bei einem Blutzucker von 46\u200amg\/dl (Referenzbereich: 74\u2013106) fand sich ein vermindertes Insulin. Auff\u00e4llig waren jedoch ein niedriges Cortisol sowie ein deutlich erh\u00f6htes ACTH, hinweisend auf eine Unterversorgung mit Hydrocortison zum Zeitpunkt der Hypoglyk\u00e4mie.<\/jats:p><jats:p>\n          Therapie und Verlauf\u2002Aufgrund der vermuteten therapeutischen L\u00fccke wurde mit der Patientin eine Dosiserh\u00f6hung des morgendlichen retardierten Hydrocortisons besprochen. Da dies keinen klinischen Erfolg hatte, wurde die Applikationsform auf morgens und abends ge\u00e4ndert.<\/jats:p><jats:p>\n          Folgerung\u2002Die vorliegende Kasuistik demonstriert, dass nicht nur ein endogener Hyperinsulinismus urs\u00e4chlich f\u00fcr Spontanhypoglyk\u00e4mien sein kann, sondern ebenfalls eine fehlerhafte Gegenregulation zu symptomatischen Unterzuckerungen f\u00fchren kann. Der MMTT sowie der 72-Stunden-Hungerversuch sollten zur Diagnostik angewendet werden. Hierbei ist darauf zu achten, dass in der Hypoglyk\u00e4mie eine unmittelbare Hormonanalytik erfolgt. Durch das Verh\u00e4ltnis von Insulin, C-Peptid sowie Proinsulin zum Blutzucker und anhand der Konstellation der kontrainsulin\u00e4ren Hormone wie Cortisol, ACTH, Wachstumshormon, Insulin-like growth factor 1 (IGF-1) sowie der Katecholamine kann eine Aussage \u00fcber die \u00c4tiologie der Hypoglyk\u00e4mie getroffen werden.<\/jats:p>","DOI":"10.1055\/a-1581-4724","type":"journal-article","created":{"date-parts":[[2021,9,23]],"date-time":"2021-09-23T01:01:30Z","timestamp":1632358890000},"page":"1294-1297","source":"Crossref","is-referenced-by-count":2,"title":["Spontanhypoglyk\u00e4mien: Eine diagnostische Herausforderung"],"prefix":"10.1055","volume":"146","author":[{"given":"Jan","family":"Adelmeyer","sequence":"additional","affiliation":[{"name":"Zentrum f\u00fcr Endokrinologie, Diabetologie & Osteologie, Universit\u00e4tsklinikum Marburg UKGM"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joachim Nils","family":"Goebel","sequence":"additional","affiliation":[{"name":"Zentrum f\u00fcr Endokrinologie, Diabetologie & Osteologie, Universit\u00e4tsklinikum Marburg UKGM"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter Hebert","family":"Kann","sequence":"additional","affiliation":[{"name":"Zentrum f\u00fcr Endokrinologie, Diabetologie & Osteologie, Universit\u00e4tsklinikum Marburg UKGM"},{"name":"Zentrum f\u00fcr Hormon- und Stoffwechselst\u00f6rungen, Deutsches Endokrinologisches Versorgungszentrum DEVZ, Frankfurt am Main"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2021,9,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1016\/j.ejim.2014.02.011","article-title":"Approach to the patient with spontaneous hypoglycemia","volume":"25","author":"P Martens","year":"2014","journal-title":"Eur J Intern 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