JRSM > Volume 95, Number 8 > Pp. 381-385

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Screening for sulphonylureas in the investigation of hypoglycaemia

P Y P Kwong MSc MRCPath     J D Teale BSc PhD  

SAS Hormone Laboratory, Clinical Laboratory, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK

Correspondence to: Pandina Kwong, Department of Clinical Biochemistry, King George Hospital, Barley Lane, Goodmayes IG3 8YB, UK E-mail: pandina.kwong{at}rbhc-tr.nthames.nhs.uk

The most important cause of hypoglycaemia in the presence of high insulin and C-peptide concentrations is insulinoma. However, a similar picture arises from use of sulphonylureas, which is sometimes covert. All specimens received in two years by a supraregional assay service laboratory from adults with low glucose and inappropriately high insulin and C-peptide concentrations were tested for sulphonylureas by a radioimmunoassay that employed antibodies to glibenclamide. In sulphonylurea-positive cases a questionnaire was sent to the consultant responsible for the patient, to elicit further information.

Samples from 93 adult patients met the criteria, and 34 (37%) of these gave a positive result on screening for sulphonylureas. The consultants provided further information on 31 of the 34, and in 20 the presence of a sulphonylurea was unexpected. In 10 the features were such as to raise the possibility of factitious drug ingestion.

A simple screening technique applied to specimens from patients with hyperinsulinaemic hypoglycaemia indicated that, in a substantial proportion of cases, the patient was taking a sulphonylurea.

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