# Three Interesting Cases of Hypoglycemia: A Case Series

## TL;DR

This paper presents three rare cases of non-diabetic hypoglycemia, highlighting the importance of accurate diagnosis for effective treatment.

## Contribution

The study contributes three distinct clinical cases of endogenous hyperinsulinemic hypoglycemia with varied etiologies.

## Key findings

- Three patients with hypoglycemia were diagnosed with insulin autoimmune syndrome, insulinoma, and drug-induced hypoglycemia.
- Accurate diagnosis through biochemical and imaging studies led to effective management and resolution of symptoms.
- The paper emphasizes the diagnostic challenges in hypoglycemia due to overlapping clinical features.

## Abstract

Hypoglycemia can be due to exogenous hyperinsulinemic hypoglycemia or endogenous hyperinsulinemic hypoglycemia (ENHH). ENHH is a rare entity characterized by inappropriately elevated plasma insulin in the background of low plasma glucose levels. ENHH, being an uncommon disease, is caused by many rare entities, with drug-induced being the most common cause of hypoglycemia. Other causes include insulinoma, insulin autoimmune syndrome, and nesidioblastosis. Here, we report three rare cases of non-diabetic hypoglycemia referred to the endocrinology clinic who had signs and symptoms of hypoglycemia fulfilling Whipple's triad with evidence of hyperinsulinemia despite low plasma glucose. All the appropriate biochemical investigations along with imaging studies were conducted to find out the etiology of hypoglycemia. After taking detailed medical history and clinical examination with biochemical and radiological investigations, patients were diagnosed with insulin autoimmune syndrome, insulinoma, and drug-induced hypoglycemia. Appropriate management was started, and patients were relieved of hypoglycemia. Diseases causing hypoglycemia have similar manifestation, but the diagnosis and management are always a challenging task. Hence, an accurate and early diagnosis is always a deciding factor for further prognosis.