{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T02:52:00Z","timestamp":1791168720325,"version":"4.1.0"},"reference-count":15,"publisher":"The Endocrine Society","issue":"11","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":10,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Hyperinsulinemic hypoglycemia (HH) is a rare but potentially dangerous condition characterized by inappropriate insulin secretion. This case describes a pediatric patient with HH in the setting of autonomic instability following neurologic injury. He was started on bethanechol, a muscarinic receptor agonist, for gastric dysmotility and developed severe, persistent hypoglycemia shortly after a dose increase with laboratory findings confirming dysregulated insulin secretion. The hypoglycemia was difficult to stabilize, requiring high glucose-infusion rates. Discontinuation of bethanechol was followed by gradual resolution. This temporal association raises the possibility that cholinergic stimulation contributed to dysregulated insulin secretion in a susceptible physiologic state. Muscarinic M3 receptors on pancreatic \u03b2-cells enhance insulin secretion, although dysregulation of this pathway by M3 agonists has primarily been demonstrated in murine models and has not previously been reported in humans. This case highlights a potential link between parasympathetic signaling and insulin regulation in autonomic instability and suggests that cholinergic agents may contribute to dysregulated glucose homeostasis in susceptible patients.<\/jats:p>","DOI":"10.1210\/jcemcr\/luag294","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T12:01:12Z","timestamp":1790769672000},"source":"Crossref","is-referenced-by-count":0,"title":["Bethanechol-associated hyperinsulinemic hypoglycemia in a child with autonomic instability"],"prefix":"10.1210","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2109-6668","authenticated-orcid":false,"given":"Rashna","family":"Soonavala","sequence":"first","affiliation":[{"name":"Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles , Los Angeles, CA 90095 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