Insulinoma presenting as hypoglycemia during lactose tolerance testing: a case report
Tóm tắt
Insulinoma is a rare functioning pancreatic endocrine tumor, typically presenting as a sporadic solitary lesion causing hypoglycemia. While these tumors can lead to marked autonomic and neuroglycopenic symptoms, the diagnosis is often delayed.
We present a case of a 60-year-old Caucasian man presenting with a 1-year history of progressive episodic confusion and an unexpected finding of symptomatic hypoglycemia during a lactose tolerance test. Further inquiry revealed an 8-year history of more subtle episodic neuroglycopenic symptoms preceding his presentation. After additional biochemical testing suggested a diagnosis of insulinoma, abdominal imaging was performed and revealed a 1.2-cm tumor in the tail of the pancreas. Following laparoscopic resection of the tumor, the patient had complete resolution of his symptoms and maintained normal glucose levels.
The clinical presentation of functioning pancreatic neuroendocrine tumors can be subtle and nonspecific. As such, clinicians should remain vigilant for insulinoma when symptomatic hypoglycemia is present. To our knowledge, this is the first report of an insulinoma found after hypoglycemia was detected during lactose tolerance testing.
Từ khóa
Tài liệu tham khảo
Service FJ, McMahon MM, O’Brien PC, Ballard DJ. Functioning insulinoma—incidence, recurrence, and long-term survival of patients: a 60-year study. Mayo Clin Proc. 1991;66(7):711–9.
Melmed S, Williams RH. Williams textbook of endocrinology. Philadelphia: Elsevier/Saunders; 2011.
Harrington MG, McGeorge AP, Ballantyne JP, Beastall G. A prospective survey for insulinomas in a neurology department. Lancet. 1983;1(8333):1094–5.
Valente LG, Antwi K, Nicolas GP, Wild D, Christ E. Clinical presentation of 54 patients with endogenous hyperinsulinaemic hypoglycaemia: a neurological chameleon (observational study). Swiss Med Wkly. 2018;148:w14682.
Eriksson B, Arnberg H, Lindgren PG, Lorelius LE, Magnusson A, Lundqvist G, et al. Neuroendocrine pancreatic tumours: clinical presentation, biochemical and histopathological findings in 84 patients. J Intern Med. 1990;228(2):103–13.
Placzkowski KA, Vella A, Thompson GB, Grant CS, Reading CC, Charboneau JW, et al. Secular trends in the presentation and management of functioning insulinoma at the Mayo Clinic, 1987–2007. J Clin Endocrinol Metab. 2009;94(4):1069–73.
Sugawa T, Murakami T, Yabe D, Kashima R, Tatsumi M, Ooshima S, et al. Hypoglycemia unawareness in insulinoma revealed with flash glucose monitoring systems. Intern Med. 2018;57(23):3407–12.
Tomazic M, Janez A, Ravnik OM. Hypoglycemia identified by a continuous glucose monitoring system in a second-trimester pregnant woman with insulinoma: a case report. J Med Case Rep. 2017;11:117.
Sugiyama Y, Kiuchi C, Suzuki M, Maruyama Y, Wakabayashi R, Ohno Y, et al. Glucose management during insulinoma resection using real-time subcutaneous continuous glucose monitoring. Case Rep Anesthesiol. 2018;2018:6248467.
Gouya H, Vignaux O, Augui J, Dousset B, Palazzo L, Louvel A, et al. CT, endoscopic sonography, and a combined protocol for preoperative evaluation of pancreatic insulinomas. AJR Am J Roentgenol. 2003;181(4):987–92.
Okabayashi T, Shima Y, Sumiyoshi T, Kozuki A, Ito S, Ogawa Y, et al. Diagnosis and management of insulinoma. World J Gastroenterol. 2013;19(6):829–37.
Nockel P, Babic B, Millo C, Herscovitch P, Patel D, Nilubol N, et al. Localization of Insulinoma Using 68Ga-DOTATATE PET/CT scan. J Clin Endocrinol Metab. 2017;102(1):195–9.
Hubalewska-Dydejczyk A, Sowa-Staszczak A, Tomaszuk M, Stefanska A. GLP-1 and exendin-4 for imaging endocrine pancreas: a review: labelled glucagon-like peptide-1 analogues: past, present and future. Q J Nucl Med Mol Imaging. 2015;59(2):152–60.