Michael A. Nauck, MD; Jurus J. Meier, MD
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-0539.
Nauck MA, Meier JJ. Diagnostic Accuracy of an “Amended” Insulin–Glucose Ratio for the Biochemical Diagnosis of Insulinomas. Ann Intern Med. 2013;158:501-502. doi: 10.7326/0003-4819-158-6-201303190-00021
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Published: Ann Intern Med. 2013;158(6):501-502.
We thank Dr. Cryer and colleagues from the Endocrine Society Task Force on the Evaluation and Management of Adult Hypoglycemic Disorders for their comments on our article. We would like to make clear that the assumption that insulin secretion ceases at a plasma glucose concentration of 1.7 mmol/L (30 mg/dL) (1) probably does not represent the true concentration–response relationship in human participants in vivo (2), but it was the basis for suggesting the “amended” insulin–glucose ratio for diagnostic purposes. Dr. Cryer and colleagues also correctly point out that the diagnostic sensitivity of this ratio for the diagnosis of insulinoma was not superior to conventional criteria as suggested by the Endocrine Society. However, our findings suggest that the “amended” insulin–glucose ratio may be more reliable in ruling out suspected insulinoma in patients presenting with typical symptoms.
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