Introduction: Pancreatic endocrine tumors are rare lesions, with an incidence of 4 cases per 1 million pts-yr. Of these lesions,insulinomas are the most common. The nonspecific symptoms and small sizes of these tumors led to difficulties of diagnosis and localization.
Case report: A 60 year female pts, had history of episodic and repetitive symptoms of strong headaches for the last 5 years; which were relieved with eating or taking glucose water orally. She noticed increased appetite over the past few years. No medications at the time of evaluation. She was obese. Normal visual field exam. On admission serum glucose level 55 mg/dl, insulin, c-peptide in normal range. Prolonged supervised fasting test was applied and produced symptomatic hypoglycemia (33 mg/dl), with slightly elevated insulinemia 26 mU/l(4-23), normal levels of C-peptide, cortisolemia and chromogranina A; interrupted on the first day after 5hours.Abdominal RMN with contrast demonstrated a well-defined hypervascular lesion involving head-body of pancreas measuring about 1.6 cm. Postoperatively the patient was discharged in good health with normal glucose level.
Conclusion: Insulinoma remains a diagnostic challenge to practitioners. This case illustrated the importance of carefully questioning and examining patient for subtle symptoms and signs of hypoglycemia. A chronic headache may hide an insulinoma.
Keywords: insulinoma, headache
20 - 23 May 2017
European Society of Endocrinology