A patient from a known family with MEN-1 was referred to the endocrine team in 1995 for endocrine screening. At that time she was well although she had hyperprolactinaemia which was attributed to macroprolactin isoforms. Subsequently she was found to have an occipital meningioma which was removed in 2002, but unfortunately developed post-operative partial seizures.
In 2006 she developed a non-functioning adenoma in the tail of the pancreas which was successfully removed by distal pancreatectomy. She remained well following this and continued to attend for regular review. In 2009 however, she complained of episodic confusion. Although it was thought these might be epileptiform, she was subjected to a 48 h fast and rapidly developed symptomatic hypoglycaemia with inappropriately high plasma insulin levels. A 2 cm insulinoma was located in the head of the pancreas by CT scanning and she underwent a modified Whipples procedure with resolution of her symptoms.
The psychological issues surrounding the decision to proceed to a second pancreatectomy operation were difficult and challenging for both the patient and her family, due to the death of a close family member after a similar problem.