Control of Refractory Fasting Hypoglycemia In a Patient with Suspected Insulinoma with Diphenylhydantoin.

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Abstract
A 65 year old patient with refractory fasting hypoglycemia and a suspected insulin secreting islet cell tumor has been successfully treated with diphenylhydantoin (DPH) for three months. With drug levels ranging from 25–32 μg/ml, postabsorptive blood sugars have remained in the normal range (93.3 ± 1.47 mg/100ml, Mean ± SE) and are strikingly elevated (p<.001) when compared to pretreatment levels (44.8 ± 6.1). Mean IRI levels during maintenance therapy were significantly lower (15.6 ± 1.1 μU/ml) than before initiation of therapy (22.6 ± 1.8, p<.005). Furthermore, the ability to sustain normoglycemia during up to 24 hours of fasting was demonstrated while on DPH. This case suggests that DPH, in nontoxic levels, may be used to control the hypoglycemia associated with islet cell adenomas and should be strongly considered for the medical management of such tumors.

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