Functional Dysinsulinism With Epileptiform Seizures

Nielsen, J. M.; Eggleston, E. L.

doi:10.1001/jama.1930.02710380028010

Cited by 11 publications

(3 citation statements)

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“…Harris (11), however, considers that a diet relatively poor in carbohydrate and rich in fat, with moderate protein, is more effective in reducing the production of insulin by the pancreas. Suprarenal extract by mouth was given in three cases as an adjuvant (19), but it did not appear to offer much advantage over diet alone. Thyroid has been tried without benefit (23).…”

Section: Case Reportmentioning

confidence: 98%

Adenoma of Pancreatic Islet Cells With Hypoglycemia and Hyperinsulinism

Liu¹,

Loucks²,

Chou³

et al. 1936

J. Clin. Invest.

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Shortly after Banting and Best's discovery of insulin (1), Harris (10) in 1924, on the basis of cases of hypoglycemia with symptoms similar to those of insulin shock and relievable by feeding, postulated the occurrence of spontaneous " hyperinsulinism " as opposed to the " hypoinsulinism " of diabetes. The first verification of this hypothesis appeared in 1927 in a report by Wilder, Allan, Power and Robertson (26) of a case of intractable hypoglycemia. The patient, on exploration, showed carcinoma of the islet tissue of the pancreas with metastasis to the liver. Insulin was demonstrated in the hepatic metastases. Two years later Howland, Campbell, Maltby and Robinson (12) reported the first case of pancreatic islet adenoma which was diagnosed preoperatively, identified at operation and excised with favorable result.In the past few years the literature on hyperinsulinism has grown tremendously. A review by Whipple and Frantz (25) of all the published cases of hyperinsulinism and islet tumor has appeared very recently. According to their analysis of the 157 cases reported, 75 cases of hypoglycemia were ascribed to hyperinsulinism without verification at operation or autopsy. Of the 82 remaining cases in which the pancreas was examined, normal tissue was recorded in 13 instances, hypertrophy of the islands in 4 instances and chronic inflammatory change in 3, leaving 62 instances in which a tumor of the pancreatic islands was found. Analyzing further the 62 cases of tumor, exactly 50 per cent were incidental necropsy findings without recorded hypoglycemia. The group of 31 cases of tumor associated with hypoglycemia consists of 10 discovered at autopsy and 21 at operation. Among the last 21 cases, 4 were instances of carcinoma in which death occurred shortly after operation in 2 instances. In February 1934 generalized clonic convulsions were first noticed, accompanied by coma. Subsequently similar seizures recurred almost every night, usually between 2 and 4 a.m. According to the description given by his wife, the onset of the seizures was marked by a cessation of the snoring which occurred regularly during sleep and the opening of his eyes accompanied by staring and grimacing. Twitching movements first involved the lower limbs and then the upper. In the beginning the movements were slight and then more violent.Occasionally the tongue was bitten. Each series of con-249

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Section: Case Reportmentioning

confidence: 98%

Adenoma of Pancreatic Islet Cells With Hypoglycemia and Hyperinsulinism

Liu¹,

Loucks²,

Chou³

et al. 1936

J. Clin. Invest.

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“…Administration of suprarenal gland by mouth has been recommended. 28 The following case, one of a series of 5, recently reported by Feinier and his collaborators, is an excellent example of hyperinsulinism due to adenoma of the pancreas with complete recovery after surgical excision of the adenoma. 26 Case 73.-Psychosis with hyperinsulinism; recovery following excision of 2 adenomata of the pancreas.-W. P., a white, married man, 36 years of age, readmitted to the Neurological Institute, New York, on Aug. 21, 1934.-His chief complaints at the time of admission were semi-conscious attacks, diplopia, and drowsiness.…”

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Psychoses Associated with Endocrine Disorders.

Rosanoff¹

1947

Manual of Psychiatry and Mental Hygiene (7th Ed.).

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Among the endocrine functions those of the thyroid gland have perhaps the greatest influence on mental condition: either insufficiency (hypothyroidism) or excess (hyperthroidism) of thyroid secretion may give rise to mental disturbances.Hypothyroidism.-Two types are distinguished: the one occurring in infancy or early childhood, spoken of as cretinism; and the other occurring in later life, spoken of as myxedema.Cases of goiter, cretinism, and combinations of both have been observed and reported, particularly in goiter regions, for more than 150 years. According to Harington x the essential relationship between goiter and cretinism was first noted by Fodere in 1800.-In 1874 Gull reported a "cretinoid state supervening in adult life in women." 2 -In 1883 Kocher and Reverdin, on the basis of results observed following surgical extirpations of enlarged thyroid glands, definitely connected the symptoms of myxedema with loss of thyroid function. 3 Cretinism is characterized by a stunting of physical and mental development. The stature is below normal; the face is pale, puffed, or marked precociously with wrinkles; the skin is dry; the hair is scant and thin; the mucous membranes are pale and thickened; the teeth are abnormal in shape and implantation and subject to caries; puberty is retarded or even absent, and the cretin may remain infantile through life. Intelligence is below normal and may be on the level of idiocy. (Fig. 42.) This condition may be associated with congenital absence of the thyroid gland, or atrophy, or a fibrous or cystic goiter.Myxedema (Gull's disease), too, is characterized by puffiness and thickening of the skin, which, in contrast with simple edema, does not show pitting on pressure; the skin is also dry, extremities cold, hair atrophied, pulse slow; menstruation is scant. Often there is obstinate constipation. Mentally the patients are dull, slow, apathetic.Etiology.-Cretinism occurs sporadically anywhere, but rarely. It is, however, endemic in certain regions, and there it is common: some 452 x i_« i. • i_ c jj.L in^v/ J. Atsr*, m S s > etc -Height 4 feet. rate which is here found to be 10% to 40% Weight 73 pounds (photo . or more below normal. graph kindly furnished by Both cretinism and myxedema are rare Dr. James Houloose, Los diseases; but there are mild forms of hypo-Angeles County Farm.) thyroidism, which are much more common, are characterized by incomplete syndromes, and present much greater diagnostic difficulties. In many cases the final diagnostic criterion is derived from the therapeutic test. According to H. Zondek 4 vari-lepliform Seizures: Treatment.

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“…Wladyczko (1925) stated that hypoglycemia was at times the causative agent in epilepsy, and for this be recommended "the sugar cure" with or without glandular therapy. Nielsen and Eggleston (1930) also reported cases of epilepsy which apparently were due to hypoglycemia and these were relieved by dietary regulation. observed three epileptics with associated hypoglycemia with improvement when the prescribed diet was followed.…”

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confidence: 99%

Neurological Manifestations of Hypoglycemia

Jordan¹

1933

N Engl J Med

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Functional Dysinsulinism With Epileptiform Seizures

Cited by 11 publications

References 3 publications

Adenoma of Pancreatic Islet Cells With Hypoglycemia and Hyperinsulinism

Adenoma of Pancreatic Islet Cells With Hypoglycemia and Hyperinsulinism

Psychoses Associated with Endocrine Disorders.

Neurological Manifestations of Hypoglycemia

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