Endo Case Challenge: A Cannabis User With Excessive Sweating and Syncope at Work

Marwa Saleem, MD; Ahmad Al Maradni, MD; Mahmoud Alsayed, MD; Ricardo Correa, MD, EdD


June 13, 2022

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.


A 32-year-old man with no significant past medical history presents to the hospital after a syncopal episode at work, which was associated with excessive sweating. His initial workup in the emergency department shows a random fingerstick glucose level of 44 mg/dL (reference range, 80-140 mg/dL). His last meal was 6 hours before his presentation. The patient reports remote episodes of being unwell and having low blood glucose levels (50-55 mg/dL) during fasting and after high-carbohydrate meals.

He uses cannabis regularly and consumes alcohol on the weekends. His family history is unremarkable for any endocrinopathies. No use of over-the-counter medications, herbal supplements, or antihyperglycemic agents is documented.


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