Insulinoma is an insulin-secreting tumour of beta cells resulting in hypoglycemia. This rare tumour presents with hypoglycemic symptoms and can be easily confused with transient ischemic attack or epilepsy or delirium. The diagnosis of an insulinoma is usually made biochemically and confirmed by localizing the tumour with imaging. We present this case of a 56 years old woman who repeatedly presented to emergency for her symptoms of diplopia and word finding difficulty. She also could not express herself properly. Each episode lasted for about 20 minutes. Her physical examination and investigations in emergency department were unremarkable, except the ECG that showed bradycardia which was believed due to her sports activity. Since she developed headache after this event, Stroke Consultant was inclined to believe that she had an episode of a migraine with aura. In some episodes she experienced diplopia, blackouts, confusion and in some she was found to have slurred speech, balance issues and was argumentative. She was reviewed during her regular neurology follow up and neurologist came across that once an ambulance was phoned and her glucose was apparently bit low. She started doing capillary blood glucose and often in the morning found glucose level of 2.1 mmol/l and 1.9 mmol/l. And once it was noticed that her symptoms might be correlated with an episode of hypoglycemia, she was referred for urgent endocrine review. During her 72 hour fast she had hypoglycaemia within few hours of the tests and results showed glucose-1.8 mmol/l, c-peptide 906 pmol/l, insulin-185 pmol/l and C-peptide-906 pmol/l. She had gallium-dotatate scan which showed intense activity neuroendocrine tumour. The tumour was less than 1 cm in diameter and was fully removed surgically. Post-operative, the patient reported complete resolution of symptoms.
08 Nov 2021 - 10 Nov 2021