Diagnosis and Management of Hyperinsulinemic Hypoglycemia

The first case of hyperinsulinism was reported in 1927, at the Mayo Clinic, when an orthopedic surgeon presented with episodes of severe hypoglycemia due to a malignant pancreatic islet cell tumor [1]. Following his death, postmortem extracts of liver metastases caused marked hypoglycemia when injected into laboratory animals. In 1929, Graham in Toronto performed the first curative operation for a benign insulinoma. Subsequent to the identification of insulinoma as the source of excessive insulin secretion, the recognition that food deprivation provoked hypoglycemia led to the evolution of the prolonged fast as the chief diagnostic test for hypoglycemia in the absence of a documented, spontaneous episode.