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Hipoglicemia não diabética

最后审阅: 21 Aug 2025
最后更新: 20 Sep 2024

小结

定义

病史和体格检查

关键诊断因素

  • diaforese
  • ansiedade
  • tremor
  • fome
  • parestesia generalizada
  • náuseas
  • palpitações
  • confusão
  • irritabilidade
  • visão turva
  • torpor
完整详情

其他诊断因素

  • ganho de peso inexplicado
  • perda de peso inexplicada
  • hiperpigmentação
  • hipotensão
  • baixa estatura
完整详情

危险因素

  • meia-idade
  • sexo feminino
  • consumo de etanol
  • cirurgia bariátrica
  • insuficiência hepática
  • insuficiência renal
  • exercícios físicos intensos
  • fibromas
  • sarcomas
  • fibrossarcomas
  • insulinoma
  • insuficiência adrenal
  • deficiência de hormônio do crescimento
  • hipopituitarismo
  • sepse
  • doenças de depósito de glicogênio
  • anorexia nervosa
  • desnutrição
  • insulina exógena
  • ingestão da fruta ackee
  • exposição ao haloperidol
  • exposição à quinina
  • exposição a fluoroquinolonas
  • exposição à sulfonilureia
  • exposição à disopiramida
  • exposição a agentes bloqueadores beta-adrenérgicos
  • exposição ao salicilato
  • exposição ao tramadol
  • exposição a inibidor de bomba de prótons
完整详情

诊断性检查

首要检查

  • glicose sérica
  • teste da função hepática
  • teste da função renal
  • insulina sérica
  • peptídeo C sérico
  • beta-hidroxibutirato sérico
  • sulfonilureia sérica
  • Níveis de hormônio estimulante da tireoide
  • cortisol sérico
完整详情

需考虑的检查

  • jejum de 48 a 72 horas sob observação
  • teste oral de tolerância à glicose
  • fator de crescimento semelhante à insulina (IGF)-II sérico
  • hormônio adrenocorticotrófico sérico
  • fator de crescimento humano (HGH) sérico
  • teste de supressão de insulina
  • pró-insulina sérica
  • TC do abdome e da pelve, com ou sem contraste intravenoso
  • ultrassonografia transabdominal
  • ultrassonografia endoscópica
  • cintilografia nucelar com octreotida
完整详情

治疗流程

急症处理

hipoglicemia reativa

exposição/overdose de medicamento, toxina, etanol

cirurgia bariátrica, anorexia, desnutrição, ingestão da fruta ackee

insulinoma

Tumor secretor de IGF-II

insuficiência renal, insuficiência hepática, sepse ou outra endocrinopatia

撰稿人

作者

Udaya Kabadi, MD

Professor of Medicine

University of Iowa

Des Moines Internal Medicine Residency Training Program

Staff Endocrinologist

Veterans Affairs Medical Center

Des Moines

IA

Disclosures

UK is an author of a number of references cited in this topic.

Acknowledgements

Professor Udaya Kabadi would like to gratefully acknowledge Dr Steven Kunkel, a previous contributor to this topic.

Disclosures

SK declares that he has no competing interests.

Peer reviewers

David J. Leehey, MD

Section Chief

Renal and Hypertension

Professor of Medicine

Division of Nephrology

Department of Medicine

Loyola University School of Medicine and Edward Hines Jr VA Medical Center

Hines

IL

Disclosures

DJL declares that he has no competing interests.

Shehzad Basaria, MD

Assistant Professor

Johns Hopkins University School of Medicine

Baltimore

MD

Disclosures

SB declares that he has no competing interests.

David Hopkins, FRCP

Clinical Director/Clinical Lead for Diabetic Medicine

King’s College Hospital NHS Foundation Trust

London

Disclosures

DH declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Vihonen H, Kuisma M, Nurmi J. Hypoglycaemia without diabetes encountered by emergency medical services: a retrospective cohort study. Scand J Trauma Resusc Emerg Med. 2018 Feb 1;26(1):12.Full text  Abstract

Kittah NE, Vella A. Management of endocrine disease: pathogenesis and management of hypoglycemia. Eur J Endocrinol. 2017 Jul;177(1):R37-47.Full text  Abstract

Kandaswamy L, Raghavan R, Pappachan JM. Spontaneous hypoglycemia: diagnostic evaluation and management. Endocrine. 2016 Jul;53(1):47-57. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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    • Society for Endocrinology guidelines for the diagnosis and management of post-bariatric hypoglycaemia
    • ENETS consensus guidelines update for the management of patients with functional pancreatic neuroendocrine tumors and non-functional pancreatic neuroendocrine tumors
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  • Patient information

    Diabetes: o que é?

    More Patient information
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