Spontaneous hypoglycemia: Should we mind the gap? Long-term follow-up of healthy people who met Whipple´s Triad

Abstract Context: Patients discharged as “healthy” with the symptom of spontaneous hypoglycemia need more attention.Objective Characterization and long-term follow-up of these patientsMethods Retrospective analysis and questionnaire follow-upSetting: Center for Endocrinology, Diabetology and Osteology at the University Hospital Marburg, Inpatient DepartmentPatients: All patients who presented to our center for the 72-hour fast between 2005 and 2018 and were discharged without an internal medicine diagnosis were included.Interventions: Survey by questionnaireMain outcome measures: Patient-reported information about current symptoms compared to original symptoms, diagnosis of insulinoma or diabetes mellitus during follow-up, matched with primary care physician data, metabolic and biometric data such as body mass index (BMI), homeostasis model assessment for insulin resistance (HOMA IR), insulin sensitivity Matsuda Index (ISI-M) and area under the curveResults A total of 41 data sets were evaluated at baseline and 38 patients were followed for an average of approximately 10 years. 61% of respondents still reported the same symptoms as at baseline. No insulinoma was missed in these patients. Only two of the 38 patients developed diabetes mellitus.Conclusion The high percentage of patients who are discharged as "healthy" and still have symptoms after many years is disturbing. It is possible that the symptoms are not due to low blood glucose. We urge caution with the term "healthy". In addition, more research should be done on this topic.