Introduction: Insulinoma is a tumour, derived from the beta cells of the pancreas. The incidence in the general population is 4 cases per million a year. 80 to 90% of insulinomas are benign and <10% are malignant.
Case presentation: A 67-year-old lady was admitted via the emergency department after being found unresponsive at home. She was found to be hypoglycaemic and responded to i.v. dextrose. She was diagnosed with type 2 diabetes mellitus a year ago and had been suffering from episodes of confusion and has had significant weight loss over 1 year. A 72 h fast test was stopped after two hours as she suffered another episode of hypoglycemia. Laboratory investigations revealed low blood glucose and elevated C Peptide levels and elevated insulin levels. She underwent CT Abdomen and Endoscopic Ultrasound which revealed a 6 cm pancreatic hypoechoic lesion and large volume right sided liver metastases. Ultrasound guided biopsy confirmed a pancreatic neuroendocrine tumour. The patient underwent successful one-step RO surgical resection distal pancreatectomy, splenectomy and right hepatectomy and was recurrence free 12 months post operatively. Her only residual problem is diabetes mellitus.
Conclusion: This case highlights a rare cause of hypoglycemia in a diabetic patient. Medical treatment with diazoxide and somatostatin analogues can be used until oncological resection. Surgical resection of insulinomas remain the main curative treatment where possible.