RT Journal Article
T1 Variables associated with endogenous hyperinsulinism in hypoglycemia diagnosis. Could the 72-hour fasting test be shortened in low-risk patients?
A1 González Vidal, Tomás
A1 Gude Sampedro, Francisco
A1 Menéndez-Torre, Edelmiro
K1 Endogenous hyperinsulinism
K1 Fasting test
K1 Hypoglycemia
K1 Insulinoma
AB Background: The 72-hour fasting test remains the standard for the diagnosis of endogenous hyperinsulinism. We investigated which variables could identify patients at low risk for endogenous hyperinsulinism, in whom a shortening of the 72-hour fasting test could be considered. Methods: This multicenter, retrospective study included 64 individuals (46 women, median age 45 years) without diabetes who underwent 72-hour fasting tests for the etiologic diagnosis of hypoglycemia. Pre- and intra-test variables were collected, including point-of-care glucose trajectories during the test. Testing was stopped before 72 h if symptomatic serum glucose <55 mg/dL or asymptomatic serum glucose ≤45 mg/dL occurred. Endogenous hyperinsulinism was diagnosed in individuals who had serum glucose <55 mg/dL, serum insulin ≥3.0 μU/mL, and serum C-peptide ≥0.6 ng/mL. Results: Patients with endogenous hyperinsulinism (n = 10) had steeper descending point-of-care glucose trajectories (p < 0.001) than those without it. Older age and lower minimum pre-test serum glucose concentrations were independently associated with endogenous hyperinsulinism. A calculator for probability prediction of endogenous hyperinsulinism was developed including these variables and sex (AUC = 0.94). Older age, female sex, lower body mass index, and lower minimum point-of-care glucose during the first 24 h of fasting were independently associated with serum glucose <55 mg/dL after the first 24 h of fasting. A calculator for predicting probability of serum glucose <55 mg/dL after the first 24 h of fasting was developed including these variables (AUC = 0.84). Conclusions: Pre- and intra-test variables can identify individuals at low risk for endogenous hyperinsulinism, in whom shortening the 72-hour fasting test could be considered.
PB Elsevier
YR 2025
FD 2025-06-01
LK https://hdl.handle.net/10347/46720
UL https://hdl.handle.net/10347/46720
LA eng
NO González-Vidal, T., Lado-Baleato, Ó., Masid, I., Gándara-Gutiérrez, C., Martínez-Tamés, G., Ares, J., Lambert, C., Riestra-Fernández, M., Gude, F., Delgado, E., & Menéndez-Torre, E. (2025). Variables associated with endogenous hyperinsulinism in hypoglycemia diagnosis. Could the 72-hour fasting test be shortened in low-risk patients? Journal of Clinical and Translational Endocrinology, 40. https://doi.org/10.1016/J.JCTE.2025.100386
NO ÓLB was supported by ISCIII Support Platforms for Clinical Research (ISCIII/PT23/00118/Co-funded by European Union). This research did not receive any other specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
DS Minerva
RD 24 abr 2026