Authors: L Czupryniak J Strzelczyk J Drzewoski
Publish Date: 2014/03/18
Volume: 28, Issue: 4, Pages: 170-174
Abstract
Insulinoma tumors are often difficult to detect as the symptoms largely precede occurrence of a visualized tumor We report the case of an insulinoma patient with long delayed diagnosis and marked adaptation to extreme hypoglycemia The patient with a 7yr history of seizures was found to have plasma glucose concentration during a starvation test as low as 16 mg/dl with no clinically significant symptoms and concomitant normal plasma insulin levels 10–30 μIU/ml All attempts to localize a tumor with repeated abdominal ultrasound examinations or computed tomography scanning were unsuccessful The patient did not tolerate the introduced oral treatment with diazoxide Once it had become technically available endoscopic ultrasonography of the pancreas was performed It revealed a 10 mm tumor in the pancreatic head The tumor was subsequently removed surgically During the operation plasma insulin concentration rose almost 15fold which confirmed the insulinsecreting character of the growth Microscopic examination revealed benign insulinoma with partially trabecular structure One month after the operation the patient had normal plasma glucose values of 60–120 mg/dl but she constantly complained of excessive thirst which occurred soon after the operation and slowly subsided in the following weeks In conclusion the present report demonstrates that insulinoma should be considered and searched for in every case of hypoglycemia associated with normal insulin levels It also confirms the essential role of endoscopic ultrasonography in the diagnosis of insulinsecreting tumors
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