Somogyi Effect in Patient With Hypopituitarism

David L. Vesely, MD, PhD; Albert Castro, PhD; Gerald S. Levey, MD
Arch Intern Med. 1976;136(8):936-938. doi:10.1001/archinte.1976.03630080070021.
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Insulin-induced posthypoglycemic hyperglycemia is an important cause of poorly controlled diabetes.1 This phenomenon, which is known as the Somogyi effect, is characterized by the following: (1) insulin-induced hypoglycemia and a rebound insulinresistant hyperglycemia; (2) negative urine tests for sugar and ketones, followed within several hours by substantial glycosuria and variable ketonuria; (3) wide daily fluctuations in blood glucose levels that are generally unrelated to dietary intake; (4) periods of mild hypothermia; and (5) nocturnal sweating and nightmares in patients with late-onset hypoglycemic effects. Although this clinical phenomenon was described initially by Somogyi and Kirstein,2 confirmed by numerous investigators,3-6 and thoroughly defined by Bloom et al,7 the basic mechanism underlying the compensatory insulin-resistant, hyperglycemia remains unexplained. A general consensus appears to have formed ascribing an important role for anterior hypophyseal hormones, particularly growth hormone, in the pathogenesis of the rebound hyperglycemia.1.8-10 This present case report demonstrates


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