CASE HISTORY AND EXAMINATION
A 44-year-old female patient was admitted to our department on January 30, 2020, following recurrent syncope and profuse sweating over the past two years, with worsening symptoms in the last month. The patient experienced recurrent syncope accompanied by profuse sweating, without an obvious trigger, for the past two years. These episodes primarily occurred in the early morning, but were alleviated by eating, with approximately one episode every six months. The patient denied any speech abnormalities or hemiplegia. Previously, the patient received treatment at a local hospital, where an intravenous random blood glucose measurement revealed a level of 54.72 mg/dL, indicating hypoglycemia. Imaging studies, including chest, abdominal, and cranial CT scans, revealed no abnormalities, and thus no additional treatment was administered.
The patient started undergoing frequent seizures approximately one month ago, occurring once a week. Accompanying these seizures, she experienced impaired consciousness and incoherent speech, with symptom relief after eating. The patient was admitted to the hospital for evaluation of syncope. Over the past two years, the patient’s dietary intake had increased, resulting in a weight gain of approximately 5 kg. Her medical history included a cesarean-section hemorrhage, followed by regular menstruation after delivery. For the past five years, she had been dealing with hypertension, although her treatment adherence was inconsistent. There were no notable findings in her family medical history.
The patient’s vital signs were stable during the physical examination. Her height measured 153 cm, weight 74 kg, with a BMI of 31.61 kg/m². The patient was alert and provided relevant answers. No signs of acanthosis nigricans or hyperpigmentation were observed on the skin or mucous membranes. Axillary and pubic hair appeared within normal limits. No enlargement of the thyroid gland was noted. Cardiopulmonary and abdominal examinations revealed no abnormalities. Muscle strength and tone in the extremities were within normal limits. No pathological signs were detected.