Postprandial hypoinsulinemic hypoglycemia as a clue to hidden purging behavior in an adolescent boy with disordered eating

Abstract

Postprandial hypoglycemia, hypoglycemia occurring within four hours of intake of meals, is an extremely uncommon condition in children. We report the case of an adolescent boy who presented with excessive hunger, poor weight gain, anasarca, hypoalbuminemia, and electrolyte imbalance. Investigating the history of post-meal drowsiness showed postprandial hypoglycemia, which on subsequent evaluation revealed elevated fasting insulin and suppressed postprandial insulin levels. This eventually led to the uncovering of a deliberately and cleverly concealed purging behavior. A meticulous interview of the family and the child confirmed the diagnosis of anorexia nervosa, binge-purging type, and averted unnecessary further investigations into the cause of failure to thrive.