Endocrine Abstracts (2016) 41 EP373 | DOI: 10.1530/endoabs.41.EP373

A rare cause of hypoglycemia in a diabetic woman: insulinoma

Kenan Çadırcı1, Faruk Yıldız1, Hakan Sevimli1, Hakan Gözcü1, Yasemin Kaya2, Havva Keskin3 & Ayşe Çarlıoğlu1

1Department of Internal Medicine, Regional Education and Research Hospital, Erzurum, Turkey; 2Department of Internal Medicine, Ordu University Hospital, Ordu, Turkey; 3Department of Internal Medicine, Göztepe Regional Education and Research Hospital, Istanbul, Turkey.

Insulinoma is generally a rare benign tumor of the pancreas islet cell. The typical clinical symptom of insulinoma are repetitive hypoglycemia attacks. Insulinoma with coexisting diabetes is extremely rare condition, We aim to present a case with insulinoma conmomittant with type 2 diabetes mellitus.

Case report: A 65-year-old woman diagnosed with type 2 diabetes mellitus was admitted by our internal medicine clinic. She complained from perspiration and tremor when she was hungry. She was taken metformin 2000 mg/day for 3 years. In the first laboratory analysis, plasma glucose was 62 mg/dl and HBA1c was 4.4%. Plasma glucose maintained to decrease, although metformin treatment was quitted because of hypoglycemia. Plasma glucose during hypoglycemia was detected 47 mg/dl, insulin 35.3 mIU/ml (2.4–23.3) and C peptide 3.51 ng/ml (0.9–4). It was performed abdominal CT for the possibility of insulinoma. In the abdominal CT, it was monitored a well-circumscribed mass, approximately in the size of 21×20×17 mm in pancreas caudal part. Distal pancreatectomy was performed in the patient. Pathological outcome of the patient was reported as insulinoma. There was no hypoglycemia in the patient after the operation.

Conclusions: It is not easy to diagnose insulinoma for hypoglycemic symptoms in diabetic patients are associated with diabetes treatment. When diabetic patients have frequent hypoglycemia, insulinoma is also thought.

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