Introduction: Hypoglucemia is one of the most common endocrine symptoms and supposes a challenging in endocrine clinical practise. In most cases, are produced in relation with diabetes (drugs and diet). In other cases, there was an endogenous insulin production which cause the symptoms.
Clinical report: A 58-year-old was attended in the Emergency Department with episodes of lightheadedness, diaphoresis, palpitation, tremulousness for month duration. In that moment, her glucose level was 45 mg/dl. The patient was admitted in Endocrinology Unit for study. The patient had obesity, hypertension in treatment with three drugs, hypercholesterolemia, aortic root dilatation and sleep apnea syndrome. The most episodes were in the evening and during prolonged fasting. The symptoms were relieved with eating something (not special food) or taking glucose water orally. She had no family history of diabetes. Physical examination revealed an obese woman weighing 118 kg and with a body mass index of 43.7 kg/m2. Hypoglycemic symptoms occurred by Prolonged fast test, simultaneously taken blood showed the glucose 49 mg/dl, plasma insulin 66.1 μUI/ml, insulin/glucose ratio was 1.34 with hypophysis-hypophysial hormonal analysis normal. CT scan showed at pancreas a nodular lesion of 35×27 mm in uncinate process, suggestive for insulinoma.
She was treated with 60 mg of oral prednisone and 100 mg diazoxide until surgery. A lesion resection was performed. The glucose and insulin levels were normal at postoperative period.
Conclusions: Insulinomas are rare pancreatic is let cell tumors with an incidence of 1 case per 250 000 person-years. Most insulinomas are sporadic and benign. The diagnosis of insulinoma is confirmed by high serum insulin concentrations during episode of hypoglucemia and surgical excision is the treatment of choice and is curative in most cases.
28 - 31 May 2016
European Society of Endocrinology