Endocrine Abstracts

82-year-old female presented with new onset seizures and confusion. The paramedical team found the capillary blood glucose (CBG) to be 2.1mM which was treated. She had a past medical history of gastrointestinal stromal tumour (GIST) which was surgically treated and being followed up by the oncology team. There was no other past history. She was caring for her disabled husband and was independent with ADLs. During admission, hypoglycaemic episodes which consistently occurred between 0300 and 0700hrs was noted. After several unsuccessful attempts at taking blood samples during the hypoglycaemic episode, one sample captured a plasma glucose value of 2.5mM with C-peptide of 862 pmol/l. HbA1C prior to the admission was 41mmol/mol. A diagnosis of ‘possible insulinoma’ was made. CT pancreas was normal (MRI not tolerated). Delirium persisted for 2 months. Due to level of frailty, she was not a candidate for surgical intervention. She was commenced on libre 2 sensors and set up on low glucose alarms. She was started on diazoxide (300 mg/day) and was discharged home with stable CBGs. One month later, she was admitted after a fall. CBG was 15 to 20mM and HbA1C was 74mmol/mol. Cognition was normal. Dose of diazoxide was reduced to 100 mg/day and due to recurrence of hypoglycaemic episodes, increased to 200 mg/day. She was discharged home with low GI dietary advice and CBG <18mM This case highlights the advantages of using alarmed flash glucose monitor in an older person without diabetes, challenges with diazoxide and the rare association of insulinoma with GIST.