MON-026 Orthostatic Hypotension (OH), Postural Orthostatic Tachycardia Syndrome (POTS), and Reactive Hypoglycemia: Are they connected?

作者：M. Fathima, Abid Khan, J. Gilden · 发表于：Journal of the Endocrine Society · 年份：2025 · DOI：10.1210/jendso/bvaf149.1358

Abstract Disclosure: M. Fathima: None. A. Khan: None. J. Gilden: Novartis Pharmaceuticals. Introduction: Hypoglycemia without diabetes mellitus (DM) is rare and is often associated with other comorbidities. When autonomic dysfunction (AN) occurs, there can be defective hormonal counter regulation which can lead to prolonged or recurrent hypoglycemia in patients without DM [1]. After a hypoglycemic episode (HYPO), patients may experience orthostatic intolerance as a symptom, relating to neurogenic orthostatic hypotension (nOH) and postural orthostatic tachycardia syndrome (POTS). Case presentation:Case 1: A 64-year-old female with known neurogenic orthostatic hypotension (nOH) and AN began experiencing dizziness/lightheadedness and had a fainting spell while taking a shower. She was also noted to have postprandial symptoms of tremors, lightheadedness, and anxiety. A continuous glucose monitor (CGM) was placed for 2 weeks. Episodes of postprandial HYPO with blood glucose values <80 were recorded, corresponding to symptoms. Lab values demonstrated: Glucose of 99, Hemoglobin A1C of 5.5%, proinsulin 5.6 pmol/L (normal <18.8 pmol/L), C-peptide 2.7 ng/ml (normal 0.81 - 3.85 ng/mL), ACTH 10 pg/ml (normal 0 - 47 pg/ml), and AM cortisol 15.47 ug/dl (normal 5.3 - 22.5 ug/dl). The patient was diagnosed with reactive HYPO without DM due to AN. Although the HYPO episodes decreased with starting acarbose 25 mg with meals, she was unable to tolerate this due to gastrointestinal symptoms and ...