Diagnosis of insulinoma may be delayed when symptoms are nonspecific. Rarely neuroglycopenic symptoms are the primary feature and these patients can be misdiagnosed as having epilepsy or neuropsychiatric disease. We report a case of insulinoma presenting as an adult-onset refractory seizure disorder. The time from onset of symptoms to diagnosis was 9 years. The atypical features of the episodes of hypoglycaemia, and the poor response to treatment led to a review of diagnosis. This case highlights the importance of considering hypoglycaemia in atypical neurological or psychiatric presentations.
Primary hyperparathyroidism (PHPT) is an uncommon cause of pancreatitis. Both acute and chronic pancreatitis has been reported in association with primary hyperparathyroidism. However the cause and effect relationship between the two still evokes controversy. We report a case of a 53 year old woman who presented with recurrent episodes of pancreatitis. Serum calcium during one of the attack was normal but repeat calcium estimation showed raised serum calcium. Eventually, the finding of an elevated intact PTH level led to preoperative localization of a parathyroid adenoma. A solitary parathyroid adenoma was found during the open neck exploration. Post-surgery, serum calcium returned to normal and there was no recurrence of the abdominal symptoms. Our paper also reviews the literature on pancreatitis and PHPT and supports our belief that pancreatitis is one of the symptoms of PHPT and it would be prudent to check serum calcium in all patients presenting with unexplained pancreatic disease.
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.