Endocrine Abstracts

Insulinoma is a functional neoplasia from pancreatic beta cells and is the most common cause of organic hyperinsulinemic hypoglycemia in adults. Of these, 90% are benign, solitary, and intrapancreatic. Here we discuss a case of 93-year-old gentleman living in a care home, with Alzheimer’s dementia, CKD, AAA, BPH. He had recurrent hospital admissions due to severe hypoglycaemia episodes treated with IV dextrose infusion. He was non-smoker and non-alcoholic. There were no family history of any hormonal problem or insulinoma or any NET. Examination was unremarkable except having intermittent confusion and reduced mobility likely due to Alzheimer’s dementia. His observation was stable. Blood test showed HBA1c of 23mmol/mol, EGFR 54/min, Normal LFT’s, Cortisol 534 nmol/l, TSH 0.49 mU/L, Insulin 549 pmol/L, C Peptide 5994 pmol/L.CTAP showed a well-defined rounded lesion measuring 23 mm in diameter at the neck of the pancreas with mild hyperenhancement in the arterial phase, suggestive of pancreatic NET with no evidence of distant metastasis. As he is very frail elderly gentleman, he was not suitable for surgical resection, hence, further investigations to localize the lesion was not considered. He was treated with injection octreotide, verapamil and diazoxide tablet initially. We managed to stop octreotide and verapamil after stabling blood sugar but continued with diazoxide 50 mg three times a day with blood sugar between 7.6 mmol/l to 15 mmol/L without further episodes of hypoglycemia. This case illustrates the importance of doing further investigations in elderly patients to identify the cause of recurrent hypoglycemia. Though hypoglycemia can be multifactorial for elderly patients including poor nutrition and organ failure but exploring further to identify any potential treatable cause likely insulinoma, can be rewarding. This may lead to improve morbidity and perhaps also helps to increase life expectancy with conventional medical treatment.