Endocrine Abstracts

Introduction: Insulinomas are rare pancreatic neuroendocrine tumours (PETS), which are usually benign and sporadic. They secrete insulin, and hence present with hypoglycaemia. We report a case of insulinoma presenting as seizures.

Case Presentation: The patient, a 16-year-old female, first had an episode of convulsion a year prior to referral to the Endocrine Clinic. She was managed at a private clinic with intravenous fluid (name unknown) and later commenced on Carbamazepine when convulsion recurred few days later. Convulsions were generalized, with dizziness and altered sensorium. Symptoms were often preceded by physical exercise and hunger, and were relieved, and prevented by intake of carbonated drinks and fruit juice. She was referred to the Neurology clinic when symptoms persisted despite use of anti-convulsant. She was later referred to the Endocrine clinic on suspicion of insulinoma when her random blood glucose was found to be low, during one of the episodes of convulsion, which occurred at the Neurology clinic. There were no symptoms suggestive of hypothyroidism or Cushing’s syndrome, and she was not on other regular drugs. She was moderately obese; other examinations were normal. She had a 72-hour prolonged fasting done, which was terminated when hypoglycaemia occurred after 12 hours: blood glucose 2.2 mmol/l, elevated serum insulin - 52.5u/ml and C-peptide - 5.85ng/ml. Other biochemical investigations and abdominal ultrasononography were normal. Abdominal Magnetic Resonance Imaging (MRI) showed an oval, well-marginated T2 hyperintense mass at the tail of the pancreas, measuring 3.64 x 3.72 x 2.63 cm in H x T x AP diameter, and suggestive of insulinoma. She subsequently had distal pancreatectomy done with complete resolution of symptoms.

Conclusion: Unusual presentations of insulinoma may delay diagnosis, result in wastage of health resources, and increase morbidities and mortalities. A high index of suspicion is needed for early detection and proper management.