Hypoglycemic sensorimotor polyneuropathy associated with insulinoma

Abstract

Hypoglycemia‐induced peripheral neuropathy due to insulinoma is unusual and, as far as we know, has previously been reported in only 34 patients. In this case report, we describe the clinical features, electrophysiological features, and pathological findings in a 37‐year‐old patient with polyneuropathy from repeated hypoglycemic episodes over a 9‐year period that related to an insulinoma. The literature is discussed. The reported case is of special interest because the peripheral neuropathy led to the correct diagnosis. © 2000 John Wiley & Sons, Inc. Muscle Nerve 23: 1891–1894, 2000

Neurologinė Patologija Sergant Kasos Ligomis

“…visų kasos insulinomų, daugumai insulinoma sergančių asmenų pasireiškia neuroglikopeniniai simptomai [10]. Insulinoma gali būti hipoglikeminės sensorinės polineuropatijos, miotoninės distrofijos, neuropsichinių sutrikimų (konfūzija, konvulsija) priežastimi [11,12,13]. Publikuota iki 40 klinikinių atvejų, kai kasos insulinoma diagnozuojama pavėluotai -ligoniams diagnozuojama temporalinės skilties epilepsija [14].…”

“…Iš 42 insulinoma sergančių ligonių 25 pirminė diagnozė buvo nervų ar psichikos liga, tikroji liga insulinoma liko nediagnozuota mažiausiai penkerius metus [12]. 37 metų insulinoma sergančiam vyrui dėl devynerių metų laikotarpiu pasikartojančių hipoglikemijos epizodų pasireiškė sensomotorinė polineuropatija [11]. 56 metų moterį, sergančią insulinomos nulemtu lėtiniu hiperinsulinizmu, dešimt…”

Common and Less Common Peripheral Nerve Disorders Associated with Diabetes

“…Although it is not clear whether hypoglycaemia in diabetic patients leads to peripheral neuropathy, there have been reports of hyperinsulinaemic states and recurrent hypoglycaemia in association with development of polyneuropathy [28]. Hypoglycaemic neuropathy is a probably very rare disorder that has previously been implicated in psychiatric patients treated with insulin shock therapy/insulin coma therapy.…”

Diabetic Neuropathies

“…Of the many patients treated for insulinoma, only about 35 cases with hypoglycemic neuropathy have been reported in the literature. 91,[93][94][95][96][97][98][99] Extrapolation from animal studies shows that in order for hypoglycemic neuropathy to occur, profound and prolonged periods of hypoglycemia are necessary. 100 It would be intuitively assumed that in such circumstances CNS damage would occur earlier and be more profound than PNS disturbance since CNS neurons are more dependent on glucose metabolism.…”