Abstract
A 90-year-old male was admitted to the hospital due to recurrent symptomatic hypoglycemia. After ruling out the most common outpatient causes of hypoglycemia, endogenous hyperinsulinism was confirmed. An abdominal computed tomography (CT) scan revealed a 15 mm solid nodular lesion in the pancreatic tail. The (68)Ga-DOTA-TOC PET-CT findings led to the diagnosis of insulinoma. A multidisciplinary committee considered the patient unfit for surgery. The treatment was started with a low dose of diazoxide; however, side effects appeared as the dose was gradually increased. Consequently, a dietary approach was prioritized, incorporating modified cornstarch (Glycosade®) in fractionated doses administered under the guidance of continuous glucose monitoring. This strategy allowed for a reduction in the diazoxide dosage and effectively prevented further hypoglycemic episodes without additional side effects. Since the initial medical treatment was successful, the patient and his family preferred to avoid other possible minimally invasive treatments unless pharmacological and dietary approaches failed.
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Fig. 1: (68)Ga-DOTA-TOC PET-CT scan (axial section).
Fig. 2: Daily glucose profile before and after starting Glycosade®.
Data availability
The data presented in this case report are available upon request from the corresponding authors.
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Funding
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Authors and Affiliations
Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
Karen Castillo, Aida Orois, Clara Viñals, Daria Roca, Cristina Montserrat-Carbonell, Betina Campero, Amanda Jiménez, Mireia Mora, Felicia A. Hanzu & Adriana Pané
Internal Medicine Department, Hospital Clínic, Barcelona, Spain
Diego Duminy-Luppi, Ana Matas & Jesús Aibar
Adult Inborn Errors of Metabolism Unit. Centros, Servicios y Unidades de Referencia en el Sistema Nacional de Salud (CSUR) para Enfermedades Metabólicas Hereditarias. Hospital Clínic, Barcelona, Spain
Cristina Montserrat-Carbonell, Ana Matas & Adriana Pané
Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
Amanda Jiménez & Adriana Pané
Fundació Clínic per la Recerca Biomèdica (FCRB)-Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
Amanda Jiménez, Jesús Aibar & Felicia A. Hanzu
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Karen Castillo
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2. Aida Orois
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3. Diego Duminy-Luppi
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4. Clara Viñals
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Contributions
KC, AO, DD-L, CV, DR, CM-C, BC, AM, and JA participated in data recording, analysis, and interpretation. KC, AO, DD-L, AJ, AM, JA, MM, FAH, and AP performed the literature review. KC, AO, DD-L, and AP wrote the manuscript. KC, DR, MM, and FAH prepared and designed the figures. KC, AO, and AP had the final responsibility for the decision to submit for publication. KC, AO, and AP are the guarantors of this work and take responsibility for the integrity and accuracy of the data. All authors have read and agreed to the final version of the manuscript.
Corresponding authors
Correspondence to Karen Castillo or Adriana Pané.
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The study adhered to the principles of the Declaration of Helsinki and the ethical standards of the Ethics Committee of Hospital Clínic, Barcelona (Spain) for case report publication. All personal data were anonymized, and informed consent was obtained from the patient’s wife.
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Castillo, K., Orois, A., Duminy-Luppi, D. et al. Modified cornstarch as an effective treatment for insulinoma-induced hypoglycemia: a case report. Eur J Clin Nutr (2025). https://doi.org/10.1038/s41430-025-01595-0
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Received:20 October 2024
Revised:23 February 2025
Accepted:07 March 2025
Published:21 March 2025
DOI:https://doi.org/10.1038/s41430-025-01595-0
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