Metastases to the thyroid gland, while rarely seen in clinical practice, can pose a diagnostic and therapeutic challenge. Most commonly, they originate from lung, renal, and breast cancer, and are generally a sign of multiorgan metastatic disease. In most cases, metastases to the thyroid gland are diagnosed incidentally on imaging studies, since they are rarely symptomatic and often do not influence thyroid function tests. Thyroid ultrasonography and fine-needle aspiration biopsy play a pivotal role in their evaluation, as both classic immunocytochemical features, and more novel molecular markers can help in the differential diagnosis. Prognosis mainly depends on the biology of the primary tumor and its extension. Communication between clinicians is essential in such patients, in order to ensure that the treatment options are carefully balanced, thus raising the need for multidisciplinary teams in their management.
We report the case of an obese 58 years old patient evaluated for hypoglycemia. The response to a prolonged fasting test was normal, but symptomatic hypoglycemia ensued after mixed meals and with oral glucose loading. A magnetic resonance scan of the abdomen revealed a pancreatic tail tumor, histologically diagnosed as benign insulinoma after successful laparotomy. "Glucose-responsive" insulinomas, although rare, have been previously described in the literature. Therefore, the diagnosis of insulinoma should also be considered in patients that exhibit postprandial rather than fasting hypoglycemia. key words: insulinoma, hyperinsulinemic hypoglycemia, postprandial hypoglycemia. Case presentationA 58 years-old male patient was admitted to "N. C. Paulescu" Institute in March 2009 for medical evaluation of hypoglicemic episodes. Two weeks prior to admission the patient experienced an episode of lipothymialike symptoms (lightheadedness, palpitations, sweating) followed by transient loss of conscience. The symptoms appeared during postprandial state (2-3 hours after a meal), when the patient was supine, wich implies a moderate physical activity. The ambulance team found the patient partially recovered, conscious, complaining of dizziness, and tested the glycemia upon arrival, with a glucometer, revealing a value of 47 mg/dl. With intravenous glucose administration the patient's state improved slowly over the next hour. Further history taking from the patient revealed similar rare episodes troughout the last year consisting of dizziness, sweating, and lipothymia (without loss of consciousness) which did not prompt the patient to seek medical attention.Clinical examination after admision was near-normal. It revealed: patient in no apparent distress, height 168 cm, weight 102 kg, BMI 36 kg/mp, abdominal circumference 115 cm, normal respiratory system, normal cardiovasculary system, BP=120/80 mmHg, HR=72 bpm, no palpable masses in the
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.