Hyperglycemia can result in severe adverse effects on the body. The mortality and morbidity of surgery are increased significantly in diabetic patients. The surgical stress-related hyperglycemia and insulin resistance can also produce the same adverse consequences. The metabolic state of the surgical patients, anesthesia method, glucose infusion, stress-induced neuroendocrine responses and insulin resistance can affect the perioperative blood glucose levels, resulting in poor clinical outcomes. The relationship between tight glycemic control and reducing post-operative mortality and morbidity is not clear. It's necessary to control blood sugar level during the perioperative period but the ideal state of glycemic control still needs a mult-center clinical trial evidence. It is generally believed that perioperative blood glucose level should be controlled below 10 mmol/L. The efficacy and safety of tight glycemic control needs further study.
Blood Glucose ; metabolism ; Humans ; Hyperglycemia ; etiology ; therapy ; Hypoglycemia ; prevention & control ; Perioperative Care

Blood Glucose ; analysis ; Humans ; Hypoglycemia ; diagnosis ; etiology ; pathology ; Male ; Somatostatinoma ; complications ; diagnosis ; pathology ; Young Adult

The medical records of six cases of nesidioblastosis were examined to determine the diagnostic approach, treatment, and neurologic sequelae. All six patients were male, and their ages at the onset of the disease ranged from one day to six months (mean 3.36 +/- 2.5 mo.). Initial clinical features were seizure, cyanosis, poor feeding, and apnea. Other subsequent symptoms were developmental delay, hyperactivity, and cold sweating. The Birth weight of the neonatal onset group was heavier than the postneonatal onset group (4.4 +/- 0.3 vs 3.26 +/- 0.04 kg). Before the diagnosis of hyperinsulinism, steroids of ACTH proved effective for seizure control. Initially, hyperinsulinemia (serum insulin greater than 10 microU/ml) was detected in four cases, but another two cases also showed hyperinsulinism by insulin/glucose(I/G) ratio greater than 0.3 during the fasting test. The glucagon response performed in 2 cases, showed normal and partial responses. Euglycemia was obtained by near total pancreatectomy (95% pancreatic resection)without malabsorption or persistent diabetes. In one case, nesidioblastoma coexisted with nesidioblastosis. Developmental delay was noted in three cases. In this group, the mean duration between symptom onset and operation was longer than the group without developmental delay (1.25 +/- 0.47 vs 0.38 +/- 0.19 yr).
Brain Damage, Chronic/*etiology ; Child, Preschool ; Developmental Disabilities/etiology ; Humans ; Hypoglycemia/blood/*etiology ; Infant ; Infant, Newborn ; Insulin/*blood ; Male ; Pancreatic Diseases/complications/*diagnosis/therapy ; Postoperative Complications/epidemiology

Prolonged administration of anterior hypophyseal, adrenocortical, or thyroid hormones is known to cause degeneration, degranulation and necrosis of the beta-cells in the Langerhans islets of the pancreas. However, the effects of extirpation of these endocrine glands upon the Langerhans islets has not been reported, a1though it is known that removal of any of these glands bring about hypoglycemia, decreased tissue uptake of glucose, and increased tissue sensitivity to insulin. The present investigation is studies of the morphologic alterations of the beta-cells in the Langerhans islets following hypophysectomy, adrenalectomy, or thyroidectomy in rats. Hypophysectomy, adrenalectomy, and thyroidectomy, all induce similar morphologic alterations in the beta-cells of the islets. These consist of increased beta-cell population, the accumlnation of beta-granules, and atrophy of the individual betacell. Therefore, these changes are considered to be not specific following the withdrawal of specific hormones but a common effect of the hypoglycemia due to removal of the hypophysis, adrenals, or thyroid glands. A similar common degeneration of the beta-cells due to hyperglycemia occurs when hormones of these endocrine glands are given excessively.
Adrenal Cortex Hormones/physiology ; Adrenalectomy* ; Animal ; Atrophy/etiology ; Blood Glucose ; Diabetes Mellitus/etiology ; Glycogen/metabolism ; Hyperglycemia/etiology ; Hypoglycemia/etiology ; Hypophysectomy* ; Insulin/secretion ; Islets of Langerhans/pathology* ; Liver Glycogen/metabolism ; Muscles/metabolism ; Myocardium/metabolism ; Necrosis/etiology ; Rats ; Staining and Labeling ; Thyroidectomy* ; Thyroxine/physiology

OBJECTIVESevere and persistent hypoglycemia often leads to brain damage in neonatal period although precise definition of hypoglycemia remains controversial. Little is known whether hypoglycemic brain damage happens to the neonates with hypoglycemic symptoms in early neonatal period and no criteria to diagnose the hypoglycemic brain damage are available. The present study aimed to characterize the clinical symptoms and brain damage by MRI diffusion-weighed imaging in the newborn infants with severe hypoglycemia in order to demonstrate the early findings of their brain damage.

METHODSThe 6 newborn infants with severe hypoglycemia (whole blood glucose ranging from 0.48 to 1.7 mmol/L) were enrolled in this study, 3 of them were premature infants, 2 were small-for-gestational age infants and 1 was an infant born to a diabetic mother. These infants had a gestational age from 35 to 40 weeks and birth weight from 1545 g to 3900 g. They had no history of perinatal asphyxia, findings indicating sepsis, intracranial infection, inborn error of metabolism or endocrine disorders. They received MRI scans from 24 hours to 48 hours after admission with the sequences of T1WI, T2WI and DWI. The parameters for T1WI of FFE CLEAR were TR/TE 126 ms/2.3 ms, Flip 80; for T2WI of TSE SENSE TR/TE 1856 - 3238 ms/80 - 100 ms, TSE Factor 15. The parameters for DWI were TR/TE 2463 ms/48 ms, EPI factor 45 and b value of 1000, respectively. Two radiologists who knew nothing of the patients' history judged the scanned results.

RESULTSThe 6 newborn infants with severe hypoglycemia showed apparent symptoms and signs indicating dysfunction of central nervous system. Repeated seizures, lethargy and apnea were the most common manifestations. Moreover, seizures recurred in 4 newborns when their blood glucoses remained in normal rage. The main types of seizure were focal and multifocal myoclonus. Intermittent widespread low voltage was seen in 2 cases by 24 hour-EEG. The first time of hypoglycemia was detected from 6 hours to 53 hours after birth in 5 cases, but 12 days in one case, the minimum mean value of blood glucose was 1.05 +/- 0.44 (0.48 - 1.70) mmol/L and repeated hypoglycemia persisted for 47.3 +/- 38.8 (4 - 96) hours. The first MRI scan was accomplished from 2 days to 5 days of life, except for one at 15 days of age. The occipital cortex and white matter were involved most frequently in all cases, but parietal region was involved in 3 cases. Occipital and/or parietal regions showed hyperintensive signals indicating "water restriction (cytotoxic edema)" on DWI for 6 cases at first scan; meanwhile hypointensity on T1WI and hyperintensity on T2WI were seen in 4 cases and one case respectively, the involved area became swollen that the occipital or parietal cortex indistinguishable from subcortical white matter. Three cases received the second scan at about two weeks of age. Hypointensity on T1WI and hyperintensity on T2WI were demonstrated in all, but hypointensity on DWI in one case only and normal signals on DWI in the others. One case was followed-up at 3 month of age, he developed normally, but delayed myelination was found on posterior limb of internal capsule and optic radiation without occipital and parietal cerebral atrophy.

CONCLUSIONSCerebral occipital and parietal regions are the most vulnerable in severe hypoglycemic condition, changes of which could appear earlier on DWI than on T1WI and T2WI. But the relationship between the early findings on MRI DWI and prognosis remains to be studied further.

Blood Glucose ; analysis ; Brain Injuries ; blood ; etiology ; pathology ; Diffusion Magnetic Resonance Imaging ; methods ; Female ; Humans ; Hypoglycemia ; blood ; complications ; Hypoglycemic Agents ; blood ; Infant, Newborn ; blood ; Magnetic Resonance Imaging ; methods ; Male ; Nervous System Diseases ; blood

We present three cases of malignant solitary fibrous tumors of the pleura (SFTP) that produced recurrent hypoglycemia. Removal of the tumors produced normoglycemia. The tumors were well circumscribed and lobulated, and consisted of firm masses weighing 1,150 g to 1,450 g with the greatest diameter of 15 to 20 cm. The tumors were composed of spindle cells in fascicles or in a haphazard arrangement and were highly cellular and mitotically active (3-8 mitoses/10 high-power fields), showing histologically malignant features. Ultrastructurally, fibroblastic features of the tumor cells were present. Insulin-like growth factors (IGF) have been implicated in the presentation of hypoglycemia. The serum insulin and C-peptide levels were not elevated. Serum IGF-I levels were also low with values of 97.4, 157.1 and 51.9 ng/mL (ref. 125-317 ng/mL), respectively. However, tumor cells were strongly positive for IGF-I receptor on immunohistochemical analysis. It is tempting to speculate that IGF-I contributes to the hypoglycemia, even though the circulating levels were low.
Aged ; Blood Glucose ; Coin Lesion, Pulmonary/chemistry/*complications/pathology ; Female ; Human ; Hypoglycemia/*etiology ; Immunohistochemistry ; Male ; Middle Age ; Pleural Neoplasms/chemistry/*complications/pathology ; Receptor, IGF Type 1/*analysis ; Recurrence

We describe an unusual case of systemic lupus erythematosus with pulmonary manifestations presenting as hypoglycemia due to anti-insulin receptor antibodies. A 38-year-old female suffered an episode of unconsciousness and was admitted to hospital where her blood glucose was found to be 18 mg/dL. During the hypoglycemic episode, her serum insulin level was inappropriately high (2,207.1 pmol/L; normal range, 18 to 173) and C-peptide level was elevated (1.7 nmol/L; normal range, 0.37 to 1.47). Further blood tests revealed the presence of antinuclear antibodies, anti-double-stranded DNA antibodies, and anti-Ro/SSA, anti-La/SSB, anti-ribonucleoprotein, and anti-insulin receptor antibodies. A computed tomography scan of the abdomen, aimed at tumor localization, such as an insulinoma, instead revealed ground-glass opacities in both lower lungs, and no abnormal finding in the abdomen. For a definitive diagnosis of the lung lesion, video-associated thoracoscopic surgery was performed and histopathological findings showed a pattern of fibrotic non-specific interstitial pneumonia.
Adult ; Autoantibodies/*blood ; *Autoimmunity ; Biological Markers/blood ; Blood Glucose/metabolism ; Female ; Humans ; Hypoglycemia/blood/*complications/immunology ; Insulin/blood ; *Insulin Resistance ; Lung Diseases, Interstitial/diagnosis/*etiology/immunology/surgery ; Lupus Erythematosus, Systemic/*complications/diagnosis/immunology ; Receptor, Insulin/*immunology ; Thoracic Surgery, Video-Assisted ; Tomography, X-Ray Computed ; Treatment Outcome