z***q
发帖数: 175 | 1 今天去考试中心模拟考试，遇到这样一道题。虽然选对了（答案是c）但是没有clue。
觉得就是insulinoma，但不明白为什么insulin正常高值，c－peptide也不高。
大家来看看：
48. A previously healthy 32-year-old woman who
works as a nurse comes to the emergency
department because of a 3-week history of
episodes of dizziness, nausea, and profuse
sweating that resolve with eating. She does not
smoke. She drinks four glasses of wine weekly.
Vital signs are within normal limits. Physical
examination shows no abnormalities. While in
the emergency department, she becomes dizzy
and diaphoretic; and her serum glucose
concentration is 45 mg/dL. Laboratory studies
obtained during the episode show:
Serum
Glucose 35 mg/dL
C peptide 0.5 ng/mL (N=0.5–2.5)
Insulin 20 μU/mL (N=5–20)
Cortisol 10 μg/dL
Urine sulfonylurea negative
Which of the following is the most likely site of
a tumor in this patient?
(A) Adrenal cortex
(B) Adrenal medulla
(C) Pancreas
(D) Parathyroid gland
(E) Pituitary gland |
e*******a
发帖数: 246 | |
z***q
发帖数: 175 | 3 看了描述的症状也觉得就是insulinoma，但能否解释一下为什么c-peptide不高？
insulin也处于正常高值。
谢谢
【在 e*******a 的大作中提到】
: insulinoma
|
e*******a
发帖数: 246 | 4 normally c-peptide is elevated in insulinoma. But there are non-typical
insulinoma patients whose c-peptide level is relatively low; Please refer
to this case report: http://www.ncbi.nlm.nih.gov/pubmed/17146148 |
t**h
发帖数: 82 | 5 通过排除法可选择。 但感觉这不应该是考Step1的题目, 估计命题的人（是不是下面文
章的作者？LOL）也没见过几例吧。
http://www.ncbi.nlm.nih.gov/pubmed/15887865 |
o**i
发帖数: 1165 | 6 这么低的glucose，insulin应该完全被抑制吧，还在正常范围已经属于不正常了
【在 z***q 的大作中提到】
: 今天去考试中心模拟考试，遇到这样一道题。虽然选对了（答案是c）但是没有clue。
: 觉得就是insulinoma，但不明白为什么insulin正常高值，c－peptide也不高。
: 大家来看看：
: 48. A previously healthy 32-year-old woman who
: works as a nurse comes to the emergency
: department because of a 3-week history of
: episodes of dizziness, nausea, and profuse
: sweating that resolve with eating. She does not
: smoke. She drinks four glasses of wine weekly.
: Vital signs are within normal limits. Physical
|
