Insulinoma presenting with postprandial hypoglycemia and a low body mass index: A case report (original) (raw)
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Insulinoma: a rare cause of a common metabolic disorder - hypoglycaemia
Sultan Qaboos University medical journal, 2008
We describe the first patient diagnosed with an insulinoma in Oman and successfully managed with a distal laparoscopic pancreatectomy. The importance of obtaining a good history from the patient and/or his family is stressed. All patients with loss of consciousness must have a Reflow check carried out and, if hypoglycaemic, this should be documented in the laboratory and a simultaneous serum sample stored for measurement of insulin, C-peptide proinsulin and sulphonylurea levels, if subsequently indicated. If magnetic resonance imaging fails to locate the tumour, endoscopic ultrasound of the pancreas, or indium 111 labelled octreotide scanning is indicated if the patient's hypoglycaemia has previously responded to treatment with octreotide.
CRITICAL TOPICS IN THE CLINICAL AND THERAPEUTIC APPROACH TO INSULINOMA: A COMPREHENSIVE REVIEW TO IMPROVE CARE AND MANAGEMENT (Atena Editora), 2024
Objective: The purpose of this literature review article is to analyze the challenges related to insulinoma, providing relevant insights into the clinical approach to these patients. Methodology: An integrative review was carried out using the PubMed database. The initial search resulted in 191 articles, of which, after applying inclusion and exclusion criteria, 12 were selected to compose the present work. Results: Studies indicate that insulinoma is a pancreatic neuroendocrine tumor associated with hypoglycemia. Endoscopic ultrasound has emerged as the most effective diagnostic method for its detection, with emphasis on its integration into the preoperative routine due to its high diagnostic value. Radical surgical resection stands out as the main treatment option, highlighting the importance of precisely identifying the location of the insulinoma before surgical intervention, aiming to increase the success rate and reduce the risk of complications. Final Considerations: This study highlights the persistence of challenges in the management of these patients, resulting both from the absence of neurogenic and neuroglycopenic symptoms and the lack of early screening for insulinomas.
Insulinoma - Is Diagnostic Delay Inevitable? Case report and Review of Literature
2015
Insulinoma is very rare tumor, patients present with features of profound hypoglycemia, life threatening coma.high degree of suspicion is required for this rare entity. Many patients are erroneously referred to psychiatrists and neurologists. In majority of the cases there is diagnostic delay of years. Some patients even die due to unnoticed severe hypoglycemia. A young male presented to us with after three years of recurrent attacks of coma, hypoglycemic symptomsin diagnosis .During these three years patient consulted several doctors even at tertiary level hospital. Even specialists missed the insulinoma and patient was erroneously diagnosed to have a psychiatric problem. Insulinoma was diagnosed when patient presented in coma that also by chance. Enucleation was performed patient recovered well and is moving forward with his life happily
Insulinoma - diagnosis and treatment based on case description
Journal of Pre-Clinical and Clinical Research, 2012
A 56-year-old patient was admitted to the Department due to recurrence of symptoms: sudden weakness, dizziness, excessive sweating, palpitations, which cleared up after food intake. Physical examinations and initial diagnostic tests did not reveal any abnormalities. Abdominal ultrasonography and magnetic resonance showed a heterogenous tumour of the pancreas with features of insulinoma. The prolonged supervised fast test that was applied induced hypoglycaemic symptoms. The level of glucose and insulin was at the lower range of the fast test. The tumor was surgically removed, and the suspicion of insulinoma was confirmed by histopathologic examination.
Wheres the Insulinoma? A clinical case report
2009
The suspicion of an insulinoma in an individual with adrenergic symptoms and / or neuroglycopenia must be the first concern in the differential diagnosis of hypoglycaemia. Insulinoma is the most frequent endocrine tumor of the pancreas and appears at any age, being more frequent between 40 and 60 years. The diagnosis is clinical and can be difficult to make in the presence of doubtful symptoms of neuroglycopenia or adrenergic symptoms after meals. Whipple´s triad of-glycemia below 50 mg/dl and symptoms / signs of hypoglycaemia that revert with administration of glucose-is strongly suggestive of insulinoma, and when associated with blood insulin inadequately high, the diagnosis is of insulinoma. The authors describe the case of a 58-year-old male patient, with a clinical picture characterized by multiple episodes of confusion, migraine, bewilderment, irritability, agitation and diaphoresis, progressing for almost 8 months. The complaints were not properly evaluated initially and the patient was treated with sedative drugs. A fasting glycemia of 38 mg/dl made insulinoma a probable diagnosis and this was confirmed by the 72 hour fasting test. Difficulties arose, as usual, in locating the tumor with imaging methods (abdominal-pelvic ultrasound and computerized tomography scan, octreotide scan and endoscopic ultrasound) and only selective arteriography with catheterization of the branches of the celiac artery revealed the tumor, located in the head of the pancreas. Surgical treatment consisted of tumor enucleation. The histological findings confirmed the diagnosis of benign insulinoma. The peculiarities of the diagnosis and particularities of the image studies in insulinoma are discussed in this article.
Insulinoma and Metabolic Urgency Case Report
International Journal of Advanced Research, 2021
Insulinoma is a rare neuroendocrine tumor, occurring almost exclusively in the pancreas. Most often unique and benign in 90% of cases. Usually sporadic, 10% of lesions become part of type 1 multiple endocrine neoplasia. The main manifestation of insulinoma is hypoglycemia, which is a life-threatening metabolic emergency. The hypoglycemia occurring in this context are particularly serious and frequent with sometimes harmful cerebral consequences. Topographic diagnosis remains difficult due to the small size of the lesions justifying the importance of the preoperative imaging required for the location of the tumor. Enucleation is the surgical indication of choice in the presence of a sporadic insulinoma that is presumably benign. Pathological and immunohistochemical examination confirms the diagnosis of neuroendocrine tumor. Our observation is particular by the circumstances of discovery of the insulinoma, the severe nature of the symptoms.
Insulinoma: is it still a diagnosis of exclusion? A case report
International Surgery Journal, 2016
Few cases of hypoglycaemic peripheral neuropathy due to insulinoma have been reported in literature. We are reporting a case of insulinoma manifesting with chronic progressive encephalopathy, intractable seizures, and neuropathy-a triad of neurological features in insulinoma. The diagnosis was delayed as the repeated investigations including dual phase CECT abdomen was normal. This case report highlights the importance of evaluation of patients for insulinoma with high resolution CECT abdomen and FDG PET scan. A keen suspicion and investigation with appropriate modality can prevent the irreversible neuroglycopenic damage, as reported in this case.
A rare cause of hypoglycemia in a type 2 diabetic patient: insulinoma
Journal of Diabetes and its Complications, 2012
Recurrent episodes of hypoglycemia in patients with diabetes are often associated with the ongoing treatment regimen. However, despite changes in treatment modalities, assessment of the causes of hypoglycemia in nondiabetic patients in the presence of severe and recurrent hypoglycemia is very important. The treatment that had been provided for 6 years in a 67-year-old female patient with type 2 diabetes mellitus was discontinued due to hypoglycemic episodes that presented for the previous 2 years. The patient experienced persistent hypoglycemia after cessation of the treatment and was hospitalized for further examination. Spontaneous hypoglycemia with a final diagnosis of insulinoma was established following histopathologic evaluation and was relieved postoperation. Insulinoma is rarely encountered as a cause of hypoglycemia in patients with type 2 diabetes. Insulin-secreting tumors should be considered where hypoglycemic episodes occur despite discontinuation of insulin and other antidiabetic treatment with endogenous hyperinsulinemia being noncompliant with the blood glycemic levels.
Diagnosis of insulinoma in a patient with hypoglycemia without obvious hyperinsulinemia
Nature Reviews Endocrinology, 2009
A 41-year-old Maltese woman with a 12-month history of severe, morning episodes of confusion, blurred vision and sweating was referred to a specialist center for evaluation of fasting hypoglycemia. She was not taking medication and did not report any prior personal or familial history of endocrinopathy or other relevant pathology.