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To the Editor:—
The interesting case presented in the Dec 21, 1964, issue ( QUESTIONS AND ANSWERS, JAMA190:1086) concerning vertigo, reduced alertness, and low blood sugar levels after eating, suggests a forme fruste of an insulin-secreting pancreatic adenoma. I agree with Dr. Hamwi that functional disease must be considered but feel very strongly that such a diagnosis should not be made until a twoday fast with good exercise is carried out. There are numerous mild chronic cases of this syndrome seen but not recognized. If the above tests were negative a diet low in carbohydrate and high in protein should be recommended, since this patient has all of her symptoms in the immediate postprandial period.David H. Kohl, MD PittsburghThe suggestion that the patient might have the forme fruste of an insulin-secreting adenoma is an interesting one. Although in the process of diagnosing pancreatic islet cell adenoma one
Hamwi GJ. Weakness and "Vertigo" in a 37-Year-Old Woman. JAMA. 1965;191(9):766. doi:10.1001/jama.1965.03080090080031
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