A patient presents with symptoms of Hypoglycemia. Investigations reveal decreased blood glucose and increased Insulin levels. C-peptide assay is done which shows normal levels of C-peptide. The most likely diagnosis is:
For the production of insulin enzymes in the pancreatic beta cells cleave the proinsulin molecule into insulin and C peptide, which are both present in insulin granules and are released in equimolar amounts when insulin is secreted into blood stream. In accidental exogenous Insulin administration, beta cell function is normal, and the release of endogenous insulin as well as C peptide is suppressed by the low circulating glucose level. Ref: Joslin's diabetes mellitus By Elliott Proctor Joslin, C. Ronald Kahn page1160; Clinical endocrinology By Ashley Grossman page 534; Problem solving in clinical medicine: from data to diagnosis By Paul Cutler page 204; Criminal poisoning: clinical and forensic perspectives By Christopher P. Holstege page 94
Insulinoma
Accidental sulfonylurea ingestion
Accidental exogenous Insulin administration
Accidental Metformin ingestion