We report a 29 year old man (staff nurse) who initially presented with a grand mal seizure in October-2003 to the neurologists. A preliminary diagnosis of epilepsy was made, though the subsequent EEG only revealed predisposition to epilepsy. In December 2004 he again presented with a grand mal seizure despite being on Epilim. He also complained of episodes of lethargy, sweating and inability to concentrate towards the end of his shifts at work for a few months prior to this. Before this admission there was a record of increased frequency of seizure like episodes. His blood glucose levels just before admission with the second seizure in December-2004 was 3 mmol/l and the paramedics had reported that his blood glucose was 1.7 mmol/l. He denied any history of sulfonylurea ingestion or exogenous insulin. Further history revealed that he had gained about 9 kgs in weight gain over the previous 12 months, though his appetite remained normal. He consumed ethanol very occasionally and was on treatment with sertaline for depression. Blood tests including thyroid functions and a short synacthen test were normal. MRI brain was essentially normal. A prolonged fast was organized and his initial overnight fasting blood glucose levels were 2.2 mmol/l with corresponding insulin and C-peptide levels being 115 picomouls per liter and 847 picomouls per liter respectively and four hours later blood glucose dropped to 2.0 mmol/l and corresponding levels of insulin and c-peptide levels were 259 picomouls per liter and 1634 picomouls per liter respectively. Urine sulfonylurea screen was negative. CT abdomen revealed a nodule in the tail of the pancreas. He underwent successful distal pancreatectomy and histology was compatible with insulinoma. Subsequent investigations confirmed normal PTH, IGF-1 and 24 hour urinary catecholamines. He now remains free of seizures without any anticonvulsant therapy and running normal blood sugar readings. This demonstrates yet another well described, but less well recognized cause of seizures.
01 - 05 Apr 2006
European Society of Endocrinology