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09-SEPTEMBER-2008 02:07:44 - Hyperinsulinism Hyperinsulinism Classification and external resources ICD-10 E15., E16.1 ICD-9 251.1 DiseasesDB 20590 eMedicine ped/1075 MeSH D006946 Hyperinsulinism or hyperinsulinemia refers to an above normal level of insulin in the blood of a person or animal. Normal insulin secretion and blood levels are closely related to the level of glucose in the blood, so that a given level of insulin can be normal for one blood glucose level but low or high for another. Hyperinsulinism can be associated with several types of medical problems, which can be roughly divided into two broad categories: those tending toward reduced sensitivity to insulin and high blood glucose levels hyperglycemia, and those tending toward excessive insulin secretion and low glucose levels hypoglycemia. Contents 1 Hyperinsulinism due to diminished sensitivity, associated with diabetes risk 2 Hyperinsulinism due to inappropriate secretion, associated with hypoglycemia 3 Hyperinsulinism due to insulin injection 4 References Hyperinsulinism due to diminished sensitivity, associated with diabetes risk Although many factors influence insulin secretion, the most important control is the amount of glucose moving from the blood into the beta cells of the pancreas. In healthy people, even small rises in blood glucose result in increased insulin secretion. As long as the pancreatic beta cells are able to sense the glucose level and produce insulin, the amount of insulin secreted is usually the amount required to maintain a fasting blood glucose between 70 and 100 mg/dL 3.9-5.6 mmol/L and a non-fasting glucose level below 140 mg/dL 7.8 mmol/L. When liver cells and others that remove glucose from the blood become less sensitive and more resistant to the insulin, the pancreas increases secretion and the level of insulin in the blood rises. This increased secretion can compensate for reduced sensitivity for many years, with maintenance of normal glucose levels. However, if insulin resistance worsens or insulin secretion ability declines, the glucose levels will begin to rise. Persistent elevation of glucose levels is termed diabetes mellitus. Typical fasting insulin levels found in this type of hyperinsulinism are above 20 μU/mL. When resistance is severe, levels can exceed 100 μU/mL. In addition to being a risk factor for type 2 diabetes, hyperinsulinism due to insulin resistance may increase blood pressure and contribute to hypertension by direct action on vascular endothelial cells the cells lining blood vessels. Hyperinsulinism has also been implicated as a contributing factor in the excessive production of androgens in polycystic ovary syndrome. The principal treatments of hyperinsulinism due to insulin resistance are measures that improve insulin sensitivity, such as weight loss, physical exercise, and drugs such as thiazolidinediones or metformin. Hyperinsulinism due to inappropriate secretion, associated with hypoglycemia Hyperinsulinism is also used in medical contexts to refer to forms of hypoglycemia caused by excessive insulin secretion. In normal children and adults, insulin secretion should be minimal when blood glucose levels fall below 70 mg/dL 3.9 mM. There are many forms of hyperinsulinemic hypoglycemia caused by various types of insulin excess. Some of those that occur in infants and young children are termed congenital hyperinsulinism. In adults, severe hyperinsulinemic hypoglycemia is often due to an insulinoma, an insulin-secreting tumor of the pancreas. Insulin levels above 3 μU/mL are inappropriate when the glucose level is below 50 mg/dL 2.8 mM, and may indicate hyperinsulinism as the cause of the hypoglycemia. The treatment of this form of hyperinsulinism depends on the cause and the severity of the hyperinsulinism, and may include surgical removal of the source of insulin, or a drug such as diazoxide or octreotide that reduces insulin secretion. Dr. Seale Harris first diagnosed hyperinsulinism in 1924 1 and also is cred with the recognition of spontaneous hypoglycemia.2 Hyperinsulinism due to insulin injection The treatment of diabetes mellitus with insulin replacement therapy can easily result in diabetic hypoglycemia due to the difficulty of balancing insulin delivery. Transient hyperinsulinism can also occur when insulin is injected by non-diabetic athletes attempting to enhance their anaerobic performance. References ^ Restore Your Health Safely and Sensibly. Liteforlife.com. Retrieved on 2007-02-24. ^ Seale Harris. Alabama State Archives. Retrieved on 2007-02-24. v d e Endocrine pathology: endocrine diseases E00-35, 240-259 Pancreas/ glucose metabolism Diabetes mellitus types: type 1, type 2, MODY, complications: coma, angiopathy, ketoacidosis, nephropathy, neuropathy, retinopathy Hypoglycemia - Hyperinsulinism - Zollinger-Ellison syndrome - insulin receptor Rabson-Mendenhall syndrome - Insulin resistance Hypothalamic/ pituitary axes Pituitary Hyperpituitarism Acromegaly, Hyperprolactinaemia, SIADH Hypopituitarism Sheehan's syndrome, Kallmann syndrome, Growth hormone deficiency, Diabetes insipidus Adiposogenital dystrophy - Empty sella syndrome - Pituitary apoplexy - ACTH deficiency Thyroid Hypothyroidism Iodine deficiency, Cretinism, Congenital hypothyroidism, Goitre, Myxedema Hyperthyroidism Graves disease, Toxic multinodular goitre, Teratoma with thyroid tissue or Struma ovarii Thyroiditis De Quervain's thyroiditis, Hashimoto's thyroiditis, Riedel's thyroiditis Euthyroid sick syndrome - Thyroid hormone resistance - Thyroid nodule Parathyroid Hypoparathyroidism Pseudohypoparathyroidism - Hyperparathyroidism Primary, Secondary, Tertiary Adrenal Adrenocortical hyperfunction: Cushing's syndrome Nelson's syndrome, Pseudo-Cushing's syndrome - Hyperaldosteronism Conn syndrome, Bartter syndrome CAH Lipoid, 3β, 11β, 17α, 21α Adrenal insufficiency Addison's disease, Waterhouse-Friderichsen syndrome - Hypoaldosteronism Gonads ovarian Polycystic ovary syndrome, Premature ovarian failure testicular 5-alpha-reductase deficiency, 17-beta-hydroxysteroid dehydrogenase deficiency general Hypogonadism, Delayed puberty, Precocious puberty Other Androgen insensitivity syndrome - Autoimmune polyendocrine syndrome - Carcinoid syndrome - Gigantism - Short stature Laron syndrome, Psychogenic dwarfism - Multiple endocrine neoplasia 1, 2 - Progeria - Woodhouse-Sakati syndrome - thymus Abscess of thymus, Thymus hyperplasia see also congenital, neoplasia Retrieved from http://en..org/wiki/Hyperinsulinism Categories: Metabolic Disorder | Endocrinology Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Português This page was last modified on 19 May 2008, at 16
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