A 13-year-old previously healthy boy presents with a 2-year history of what is described as 4 episodes of unusual behavior. During these episodes he becomes acutely upset, with complaints of palpitations, tremors, and hunger that resolve several minutes after eating. He describes additional episodes not associated with hunger during which he feels dizzy and presyncopal for a minute, occurring approximately once every 6 months. These occur within minutes of eating and/or drinking, and none have occurred after an overnight fast. There is no flushing or pallor noted by observers during these events. He does not have access to insulin or sulfonylureas.

He was seen by neurology 4 months earlier and was diagnosed as having focal seizures and started on antiseizure medications. He presents to the emergency department after an episode of potential seizure activity and is found to have a point-of-care blood glucose level of 57.6 mg/dL (3.2 mmol/L). This...

You do not currently have access to this content.