A Case of Insulinoma With Provoked Seizures for the Past Fourteen Years: A Case Report

Abstract

Introduction: Insulinoma is one of the most common neuro-endocrine tumors of the pancreas. Some cases with insulinoma present neuropsychiatric symptoms and are often misdiagnosed as psychosis thus patients may remain symptomatic from one week to as long as several decades before diagnosis. Case Presentation: A 68-year-old male patient, who presented episodic seizures and a normal Electroencephalography (EEG) recording for the past fourteen years, had referred for evaluation of hypoglycemia. His biochemical profile revealed blood glucose of 45mg/dL. His C-peptide and insulin levels were elevated. Endoscopic pancreatic ultrasonography (EUS) revealed two mass lesions in pancreatic head. Pathological evaluation revealed well-differentiated endocrine neoplasm and granulomatous reaction in lymph nodes. After resection of the tumor, his symptoms resolved and he became seizure free. Conclusions: Some cases with insulinoma that present neuropsychiatric symptoms might remain symptomatic for several decades before diagnosis. Therefore, it is important for physicians to be aware of presentations of insulinoma to avoid diagnostic delays.