{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T06:17:53Z","timestamp":1788675473274,"version":"build-2803163510"},"reference-count":13,"publisher":"The Endocrine Society","issue":"3","license":[{"start":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T00:00:00Z","timestamp":1741824000000},"content-version":"vor","delay-in-days":31,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,2,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Endogenous hyperinsulinemia hypoglycemia has numerous etiologies. The objective of this report is to describe a patient with severe hyperinsulinemic hypoglycemia with no known history of diabetes or hypoglycemia who presented with acute altered mental status. Blood glucose was noted to be 40\u2005mg\/dL (2.22\u2005mmol\/L) (reference range 65-125\u2005mg\/dL; 3.61-6.94\u2005mmol\/L). The patient's sulfonylurea screen was negative. Following 1\u2005mg glucagon injection, the patient's glucose did not improve, a response inconsistent with insulinoma. Imaging studies of the pancreas did not show pancreatic mass. Two weeks before the presentation, the patient started on tramadol for back pain with the dose increased 3 days prior to presentation. The patient's hypoglycemia resolved and returned to baseline 4 days after the initial presentation. Tramadol has been reported to cause hypoglycemia, especially in the elderly population. Tramadol may act on \u03bc receptors on \u03b2 cells to upregulate insulin secretion. When approaching a patient with endogenous hyperinsulinemia, one should consider tramadol or other analgesics as a possible etiology.<\/jats:p>","DOI":"10.1210\/jcemcr\/luaf034","type":"journal-article","created":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T05:32:18Z","timestamp":1741843938000},"source":"Crossref","is-referenced-by-count":3,"title":["Insulinoma Mimic: Tramadol-induced Hypoglycemia"],"prefix":"10.1210","volume":"3","author":[{"given":"Shannon","family":"O\u2019Hara","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, West Virginia University School of Medicine , Morgantown, WV 26506 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler","family":"Hinshaw","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, West Virginia University School of Medicine , Morgantown, WV 26506 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathew","family":"McKenzie","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, West Virginia University School of Medicine , Morgantown, WV 26506 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Belcher","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, West Virginia University School of Medicine , Morgantown, WV 26506 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"McCoy","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, West Virginia University School of Medicine , Morgantown, WV 26506 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2711-2497","authenticated-orcid":false,"given":"Adnan","family":"Haider","sequence":"additional","affiliation":[{"name":"Section of Endocrinology and Metabolism, Department of Internal Medicine, West Virginia University School of Medicine , Morgantown, WV 26505 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2025,3,13]]},"reference":[{"issue":"Supplement 2","key":"2025031305320879500_luaf034-B1","doi-asserted-by":"crossref","first-page":"18","DOI":"10.2165\/00003495-199700532-00006","article-title":"[Pharmacology of tramadol]","volume":"53","author":"Dayer","year":"1997","journal-title":"Drugs"},{"key":"2025031305320879500_luaf034-B2","doi-asserted-by":"crossref","first-page":"303","DOI":"10.2147\/NSS.S348834","article-title":"The relationship between postoperative opioid analgesia and sleep apnea severity in patients undergoing hip arthroplasty: a randomized, controlled, triple-blinded trial","volume":"14","author":"Albrecht","year":"2022","journal-title":"Nat Sci Sleep"},{"issue":"6","key":"2025031305320879500_luaf034-B3","doi-asserted-by":"crossref","first-page":"e151","DOI":"10.4158\/EP12070.CR","article-title":"Danger of hypoglycemia due to acute tramadol poisoning","volume":"18","author":"Mugunthan","year":"2012","journal-title":"Endocr Pract"},{"issue":"12","key":"2025031305320879500_luaf034-B4","doi-asserted-by":"crossref","first-page":"1842","DOI":"10.1016\/S0755-4982(06)74913-2","article-title":"Hypoglyc\u00e9mie lors d'un traitement par tramadol. 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