Estimulación magnética transcraneal repetitiva en un paciente con tinnitus bilateral crónico / Repeated transcranial magnetic stimulation in a patient with chronic bilateral tinnitus

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[Severe hypoglycemia secondary to angiotensin-converting-enzyme inhibitors in the absence of diabetes mellitus. Report of a case]. / Hipoglucemia severa secundaria a inhibidores de la enzima convertidora de angiotensina en ausencia de diabetes mellitus. Reporte de un caso.

We present the first reported case of untreatable hypoglycemia in a woman of 66-years-old, non-diabetic who received captopril for six years, and more recently ramipril. Six months ago, she was seen for the first time in our hospital. We found her disoriented, sweaty and confusing words frequently. Glucose tolerance test one hour after administration of glucose: 53 mg/dl. Test of insulin and C peptide had norms the same as the other contra-regulator hormones except glucagon with moderate elevation. The B.P. increased and we changed to ramipril, which improved the pressure but the hypoglycemia persisted. A new change was made to Losartan plus hydrochlorothiazide; after 72 hours patient improved. A new glucose tolerance test one hour after administration of glucose is absolutely normal. General conditions of the patients are observed more than 3 months and are asymptomatic. The B. P. is normal and we are keeping only the recently installed treatment.