We present the observation of a patient in whom the diagnostic of insulinoma was difficult in front of normality on the classically used indexes. A 63-year-old patient, whithout any antecedent or drug used, was admitted in our service after a hypoglycaemic coma (glycaemia 1.21 mmol/l, insulinemia not measured). Clinical examination was normal. We performed a fasting testing. Results are listed in this table:
|Time||7 am||1 pm||1 am|
|Glycaemia (Gly) mmol/||2.9||2.1||2.50|
|Insulinemia (Ins) mU/l N (2 17)||4.12||3.29||4.38|
|Turner index N<50||18.72||47||29.2|
Glycaemia indexes were normal, as well as the initial interpretation of abdominal scan, but, the diagnosis of insulinoma was suspected. So we performed an echo endoscopy which shows a mass of one centimeter in the pancreatic isthmus. Transgastric ponction of this mass shows a neuro-endocrine proliferation cells compatible with an insulinoma. In spite of a treatment by octreotide, hypoglycaemias was frequent and sever. The patient was sent to a surgeon who practiced a enucleo-resection with immediate result on hypoglycaemias. Insulinoma was confirmed by the anathomo-pathologist. The interest of this well-known observation is in one hand to discuss the validity of glycaemia indexes. With the new technics who detect only insulinemia and not pro-insulinemi, they are inadequat and should be left. With the new technics any insulinemia superior to 2 mU/ml concomitant of a glycaemia under 2.2 mmol/l allows the diagnostic. In the other hand to show the interest of transgastric biopsy during echo-endoscopy when evaluating pancreatic mass. Finally the enucleo-resection with coeliscopy wich reduces the morbidity.
01 - 05 Apr 2006
European Society of Endocrinology