SAT-870 - A Case of Hypoglycaemic Symptoms in Non-Hypoglycaemic Patient Whose Symptoms Improved on Oral Octreotide: A Case Report

Introduction: The coexistence of hyperglycaemia, subjective hypoglycaemic symptoms, and hyperinsulinemia in the absence of an identifiable endogenous insulin producing tumor is uncommon but can functionally impair patients. Clinicians undergo diagnostic and therapeutic challenges to care for these patients, and sometimes even attribute such presentations to somatization, leading to diagnostic overshadowing. Clinical guidelines to manage such patients are limited requiring further exploration.
Case summary: A 27-year-old female with polycystic ovarian syndrome (PCOS),
Hashimoto’s thyroiditis and migraine (treated with metoprolol) presented with a history of subjective hypoglycaemia-like symptoms that occurred approximately 20 to 30 episodes per day, including during physical activity and sleep. Patient increased her meal frequency and intake of glucose tablets to relieve the symptoms. Laboratory values indicated hyperinsulinemia, elevated AM cortisol, C-peptide, thyroid stimulating hormone (TSH) and free testosterone, and normal hemoglobin A1C (HgA1C), glucose levels, estimated glomerular filtration rate (eGFR), follicular stimulating hormone (FSH), prolactin, insulin-like growth factor 1(IGF1), free thyroxine (T4), and negative islet cell autoantibody. Causes of hyperinsulinism, for example, insulinomas, growth hormone dysfunction and autoimmune disorders were ruled out.
Intervention and Outcome: A trial of 20 mg oral octreotide (Mycapssa) once daily along with continuous glucose monitoring provided notable improvement demonstrated by increase in inter-meal duration, decrease in episodes of sudden hypoglycaemia and reduction in subjective hypoglycaemic symptoms.
Clinical relevance: This case sheds new light on oral octreotide (Mycapssa) as an effective therapeutic agent in decreasing the delta drop of unexplained blood sugar levels and symptom management in patients with hypoglycaemia-like symptoms, hyperinsulinemia, insulin resistance and fluctuation between hyperglycemia and hypoglycaemia. Furthermore, this case highlights the importance of focusing on diagnostic gap and treatment instead of misattribution of the
patient’s symptoms to psychological factors.
Key words- Hyperglycemia, Octreotide, hyperinsulinemia, hypoglycemia, MEN

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