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require 6 36 months to recover normal function Hydrocortisone or prednisone replacement therapy is necessary in the meantime Patients who do not have a remission (or who have a recurrence) should be treated by bilateral laparoscopic adrenalectomy Another treatment option for patients with ACTH-secreting pituitary tumors is stereotactic pituitary radiosurgery (gamma knife or cyberknife), which normalizes urine free cortisol in two-thirds of patients within 12 months Conventional radiation therapy results in a 23% cure rate Pituitary radiosurgery can also be used to treat Nelson s syndrome, the progressive enlargement of ACTH-secreting pituitary tumors following bilateral adrenalectomy Patients who are not surgical candidates may be given a trial of ketoconazole in doses of about 200 mg every 6 hours; liver enzymes must be monitored for progressive elevation Adrenal neoplasms secreting cortisol are resected laparoscopically The contralateral adrenal is suppressed, so postoperative hydrocortisone replacement is required until recovery occurs Metastatic adrenal carcinomas may be treated with mitotane; ketoconazole or metyrapone can help suppress hypercortisolism in unresectable adrenal carcinoma Ectopic ACTH-secreting tumors should be located, when possible, and surgically resected If that cannot be done, laparoscopic bilateral adrenalectomy is recommended Medical treatment with ketoconazole or metyrapone (or both) may partially suppress the hypercortisolism; however, metyrapone may exacerbate female virilization The somatostatin analog octreotide, given parenterally, suppresses ACTH secretion in about one-third of such cases

During the postabsorptive state, normal plasma glucose is maintained by hepatic glucose output derived from both glycogenolysis and gluconeogenesis With prolonged starvation, glycogen reserves become depleted within 18 24 hours and hepatic glucose output becomes totally dependent on gluconeogenesis Under these circumstances, a blood concentration of ethanol as low as 45 mg/dL can induce profound hypoglycemia by blocking gluconeogenesis Neuroglycopenia in a patient whose breath smells of alcohol may be mistaken for alcoholic stupor Prevention consists of adequate food intake during ethanol ingestion Therapy consists of glucose

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This rare cause of hypoglycemia, documented in isolated case reports, may occur as two distinct disorders: one associated with spontaneous development of circulating antiinsulin antibodies and another associated with antibodies to insulin receptors, in which the antibodies apparently have agonist capabilities This latter disorder is extremely rare, having been documented in no more than five cases However, development of anti-insulin antibodies has been reported in over 200 patients most of whom were being treated with methimazole for thyrotoxicosis In Western countries, 23 cases have been reported and include patients with a lupus-like syndrome or with various paraproteinemias The hypoglycemia occurs 3 4 hours after meals

following an initial postprandial hyperglycemic phase that is due to the antibodies interfering with the exit of insulin from the plasma to reach its target tissues Later, after most of the meal is absorbed, inappropriate high levels of insulin dissociate from this antibody-bound compartment, resulting in hypoglycemia Insulin levels in excess of 1000 pmol/L are observed at time of hypoglycemia, and these persons have high titers of insulin autoantibodies

Description Ends the current transaction Moves you from anywhere into transaction xxxx Note, however, that you are terminating the current screen and will lose any unsaved data Moves you from anywhere into the sales screen [VA00] Deletes the current session Logs off from the system Logs off from the system without a confirmation prompt Generates a session list (A session is a window into SAP similar to , having multiple documents/windows open in an application on a pc) Opens transaction xxxx in a new session Opens transaction VA00 in a new session

Basu A et al Insulin autoimmunity and hypoglycemia in seven white patients Endocr Pract 2005 Mar Apr;11(2):97 103 [PMID: 15901524] Kim CH et al Autoimmune hypoglycemia in a type 2 diabetic patient with anti-insulin and insulin receptor antibodies Diabetes Care 2004 Jan;27(1):288 9 [PMID: 14694017] Sahin M et al Autoimmune hypoglycemia in a type 2 diabetic patient with anti-insulin and insulin receptor antibodies Diabetes Care 2004 May;27(5):1246 7 [PMID: 15111569] Yaturu S et al Severe autoimmune hypoglycemia with insulin antibodies necessitating plasmapheresis Endocr Pract 2004 Jan Feb;10(1):49 54 [PMID: 15251622]

A number of drugs apart from the sulfonylureas can occasionally cause hypoglycemia, especially when ingested in large amounts These include quinine, quinidine, disopyramide, and salicylates ACE inhibitors, when taken with antidiabetic drugs, can cause hypoglycemia possibly by improving insulin sensitivity Recently, it has been reported that the use of gatifloxacin (an antibiotic that is no longer available in the United States) in diabetic patients is associated with serious hypoglycemic and hyperglycemic reactions Ten to 20 percent of patients receiving pentamidine for Pneumocystis jiroveci pneumonia develop symptomatic hypoglycemia, particularly when the drug is administered intravenously This apparently is due to lytic destruction of pancreatic B cells, causing acute hyperinsulinemia and hypoglycemia It is later followed by insulinopenia and hyperglycemia, which occasionally is persistent Since other drugs have been found to be as effective in treating Pneumocystis pneumonia, pentamidine administration and its hypoglycemic sequelae are less frequently encountered

For patients with known cardiovascular disease (secondary prevention), cholesterol lowering leads to a consistent reduction in total mortality and recurrent cardiovascular events in men and women and in middle-aged and older patients Among patients without cardiovascular disease (primary prevention), the data are less conclusive, with rates of cardiovascular events, heart disease mortality, and all-cause mortality differing among studies Nonetheless, treatment algorithms have been designed to assist clinicians in selecting patients for cholesterol-lowering therapy based on their lipid levels and their overall risk of developing cardiovascular disease

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