2. Case report
A 74-year-old male patient with a history of hypertension 15 years ago, type 2 diabetes mellitus 20 years ago with metformin 850mg q.d treatment, presents with mMRC2 grade dyspnea, chest pain that has not radiated for two weeks before admission. Due to sudden loss of consciousness, he is taken by emergency, being immediately referred to the Shock Trauma Unit (Glasgow 10/15), to control vital functions: BP: 170/90 mmHg, HR: 90 bpm, FR: 26 rpm, SATO2: 95%, FIO2: 21%, and on preferential clinical examination: vesicular murmur is found abolished in the left hemithorax and preserved in the right hemithorax, no added sounds are heard.
We take capillary blood glucose (38 mg/dl), classifying it as acute encephalopathy without neurological targeting and symptomatic hypoglycemia. Glucose infusion serum treatment is administered, recovering consciousness without any neurological sequelae. A computerized axial tomography of the chest without contrast was performed, showing a mass and left pleural effusion (Fig. 1). The patient in his serial capillary glycemia controls presents episodes of symptomatic, sustained and persistent recurrent hypoglycemia, for which treatment with glucose serum is maintained. In hematic biometry controls we found a glycosylated hemoglobin (HbA1c): 5.7%, basal cortisol 8am of 5.9 mg/dl, insulin-like growth factor I (IGF I): 74 ng/ml, peptide C: 0.01 ng/dL, and basal insulin of 0.04 U/I.