Hiện nay, bệnh nhân rối loạn này thường có kháng thể insulin không phát hiện, có thể vì việc sử dụng insulin của con người, đó là kháng nguyên ít hơn so với mẫu có nguồn gốc từ động vật. | 206 Service the C-peptide test in comparison with the prolonged supervised fast. The C-peptide suppression test has been modified as hyperinsulinemic euglycemic or hypoglycemic clamps 78 . No diagnostic criteria have been generated from these procedures. Insulin Antibodies The detection of insulin antibodies was once considered to be firm evidence of factitious hypoglycemia due to self-administered insulin 79 especially when animal insulin was the only commercially available type. Currently patients with this disorder usually have no detectable insulin antibodies possibly because of the use of human insulin which is less antigenic than the form derived from animals. The presence of insulin antibodies has been considered to be the sine qua non for a diagnosis of insulin autoimmune hypoglycemia 19 but low titers of antibodies may be detected in persons without hypoglycemia 80 and in rare instance in patients with insulinomas 81 . Glycated Hemoglobin Glycated hemoglobin concentrations affinity chromatography are statistically significantly lower in patients with insulinomas than in control subjects. However there is too much overlap to provide a diagnostic criterion 82 Fig. 6 . Nevertheless a value uniformly was associated with insulinoma but only 25 of patients with insulioma had values in that range. Imaging Studies There has been a consensus among endocrinologists that the diagnosis of a hypoglycemic disorder should be made biochemically. Should the data point to a pancreatic lesion localization procedures are then undertaken. The success in localization often depends on local skill and experience. Ultrasound is heavily operator-dependent computed tomography CT is technologically dependent . best results with triple phase technique. Octreoscan has been generally disappointing. Transhepatic portal venous sampling for insulin has been abandoned by major centers. Merging of localization and diagnostic maneuvers has occurred with the development of the selective
