Endocrine Abstracts

JOINT1888

Insulinomas are rare pancreatic neuroendocrine tumors characterized by excessive insulin production, which leads to recurrent episodes of hypoglycemia. While most patients exhibit typical symptoms such as confusion and diaphoresis, a subset may experience hypoglycemia unawareness. This condition arises when repeated episodes of low blood glucose levels impair the body’s autonomic responses, hindering the patient’s ability to recognize early warning signs of impending hypoglycemia. Consequently, this can lead to delayed diagnoses and heightened risk of severe complications, including seizures, coma, or accidents. We present the case of a 69-year-old male diagnosed with insulinoma following a motor vehicle accident that revealed an alarming blood glucose level of 2.8 mmol/l, despite the patient reporting no symptoms. Subsequent investigations, including a supervised 72-hour fast, demonstrated inappropriately elevated C-peptide levels (1350 pmol/l) and insulin levels (14 mU/l) with a lab glucose reading of 2.2 mmol/l. A CT scan of the pancreas identified a 1.25 cm enhancing lesion in the proximal body, consistent with insulinoma. The patient successfully underwent a Whipple procedure, and his postoperative recovery was uneventful. This case highlights the diagnostic challenges associated with insulinomas, particularly in patients who exhibit hypoglycemia unawareness. It emphasizes the importance of considering insulinoma in the differential diagnosis for patients presenting with hypoglycemia unawareness. Early recognition and intervention are crucial to prevent serious complications associated with this condition.