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What Causes Persistent Fever?
My wife has run fevers almost everyday for 2 years. Tests show that she has NO infection. 10 years ago she had a gastric bypass that had to be repaired. She also has a lot of problems with overproduction of insulin. It has been surmised that she could have an insulinoma but no scans have turned that up. The fever is what makes her feel so bad. We did stop her thyroid medication for a week thinking that that could be a fever source, but she continued to have fevers. She s had Octreo (sp?) scan where isotopes were injected to try and locate a tumor but nothing related to the pancreas showed up. We are at a total loss and don t know where else to look except Mayo Clinic. She s really suffering
Tue, 29 Jan 2019
Hi,
There is increased occurrence of hypoglycemia after gastric bypass surgery for obesity.
A new entity, insulinomatosis, is described that can cause hypoglycemia and mimic insulinomas. It occurs in 10% of patients with
persistent hyperinsulinemic hypoglycemia and is characterized by the occurrence of multiple macro-/microadenomas expressing insulin, and it is difficult to distinguish this entity from insulinoma.
When the cause of fever of unknown origin (FUO) is elusive/obscure,18F-Fluorodeoxyglucose (FDG) positron emission tomography (PET) combined with CT is the imaging procedure of choice after the initial investigations. FDG accumulates in tissues with a high rate of glycolysis, which occurs not only in malignant cells but also in activated leukocytes and thus permits the imaging of acute and chronic inflammatory processes.
Repetition of a thorough history-taking and physical examination and review of laboratory results and imaging studies (including those from other hospitals) are recommended.
However, in patients with persisting FUO, waiting for new PDCs (potential diagnostic clues) to appear probably is better than ordering more screening investigations.
Hope I have answered your query. Let me know if I can assist you further.
Regards,
Dr. Tushar Kanti Biswas,
Internal Medicine Specialist
There is increased occurrence of hypoglycemia after gastric bypass surgery for obesity.
A new entity, insulinomatosis, is described that can cause hypoglycemia and mimic insulinomas. It occurs in 10% of patients with
persistent hyperinsulinemic hypoglycemia and is characterized by the occurrence of multiple macro-/microadenomas expressing insulin, and it is difficult to distinguish this entity from insulinoma.
When the cause of fever of unknown origin (FUO) is elusive/obscure,18F-Fluorodeoxyglucose (FDG) positron emission tomography (PET) combined with CT is the imaging procedure of choice after the initial investigations. FDG accumulates in tissues with a high rate of glycolysis, which occurs not only in malignant cells but also in activated leukocytes and thus permits the imaging of acute and chronic inflammatory processes.
Repetition of a thorough history-taking and physical examination and review of laboratory results and imaging studies (including those from other hospitals) are recommended.
However, in patients with persisting FUO, waiting for new PDCs (potential diagnostic clues) to appear probably is better than ordering more screening investigations.
Hope I have answered your query. Let me know if I can assist you further.
Regards,
Dr. Tushar Kanti Biswas,
Internal Medicine Specialist
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