12-24-2011, 11:55 AM
A 28-year-old man is evaluated for a 2-month history of recurrent confusion, palpitations, and diaphoresis occurring whenever he misses breakfast. The symptoms are relieved with eating. His medical history is otherwise unremarkable, and he takes no medications.
On physical examination, vital signs are normal, and BMI is 26. The results of the general physical examination are normal.
Results of laboratory studies show a fasting plasma glucose level of 52 mg/dL (2.9 mmol/L) and an insulin level of 18 µU/mL (129.9 pmol/L) (normal range, 2 to 20 µU/mL [14.4 to 144.3 pmol/L]).
Which of the following is the most appropriate next step in diagnosis?
A CT of the abdomen
B Endoscopic ultrasonography of the pancreas
C Home glucose monitoring
D Octreotide scan
E Supervised 72-hour fast in the hospital