Insulinoma in a Patient with Normal Results from Prolonged Fast and Glucagon-Induced Hypoglycemia

Soh, Abel Wah Ek; Kek, Peng Chin

doi:10.4158/ep10073.cr

Cited by 16 publications

(9 citation statements)

References 18 publications

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“…Recently, Placzkowski et al reported that 6% (13 of 214) of the patients at the Mayo Clinic certain presented with postprandial hypoglycemia, 3 of the cases with negative supervised fasts, suggesting that insulinomas have diverse characteristics [10]. A glucagon injection test is sometimes used in order to precipitate hypoglycemia in patients with normal glycemic values even after prolonged fasting [8,9]. In our patient hyperinsulinemic hypoglycemia was precipitated by mixed meals and also appeared after oral glucose load.…”

Section: Disscusionmentioning

confidence: 71%

“…To date, several case reports on insulinoma patients who exhibited postprandial hypoglycemia have been published [7,8,9]. Recently, Placzkowski et al reported that 6% (13 of 214) of the patients at the Mayo Clinic certain presented with postprandial hypoglycemia, 3 of the cases with negative supervised fasts, suggesting that insulinomas have diverse characteristics [10].…”

Section: Disscusionmentioning

confidence: 99%

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Pancreatic Insulinoma Presenting with Postprandial Hypoglicemias

Florentiu

Barbu

Mitrache

et al. 2012

Romanian Journal of Diabetes Nutrition and Metabolic Diseases

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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

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Section: Disscusionmentioning

confidence: 71%

Section: Disscusionmentioning

confidence: 99%

Pancreatic Insulinoma Presenting with Postprandial Hypoglicemias

Florentiu

Barbu

Mitrache

et al. 2012

Romanian Journal of Diabetes Nutrition and Metabolic Diseases

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“…However, it should be noted that normal results from a prolonged fast do not preclude an insulinoma 22 .…”

Section: Discussionmentioning

confidence: 97%

Şüpheli Davranış ve Kişisel Değişimler ile Karışık Kısmi Epilepsinin Yanlış Teşhisi

Kasnazan¹,

Amin²,

Seerwan³

et al. 2014

Cukurova Medical Journal

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Pancreatic insulinomas are rare endocrine tumors and their diagnosis needs a high index of suspicion. Several patients receive an initial misdiagnosis before the tumor is being finally detected. We report on two patients who presented with vague and bizarre personality and behavioral changes. One patient was initially diagnosed with hysteria and both eventually were diagnosed with complex partial epilepsy. They had not improved on anti-epileptic medications and their symptomatology continued to deteriorate. Their final diagnosis turned out to be pancreatic insulinoma. Because of the rarity of insulinomas as well as their diverse and non-pathognomonic symptoms, the diagnosis remains challenging and may quite well escape detection unless it is entertained. Key Words: İnsulinoma; pancreatic islet cell tumor; complex partial seizures; behavioral changes; personality disorders ÖZET Pankreatik insülinom nadir görülen endokrin tümörü olup teşhisi ciddi anlamda yüksek şüphe gerektirmektedir. Hastaların çoğuna son aşamada gözlenen tümör bulgusundan önce yanlış teşhis konulmaktadır. Bu raporda belirsiz ve şüpheli davranış gösteren iki hastayı ele aldık. Hastanın birine ilk olarak histeri teşhisi konmasına ragmen sonunda her ikisine birden karışık kısmi epilepsi tanısı kondu. Her ikisine anti-epileptik ilaçlar verilmesine rağmen iyileşme gözlenmedi ve belirtileri bu durum daha kötü hale gelene kadar devam etti. Son olarak pankreatik insülinom hastası oldukları ortaya çıktı. İnsülinomlar farklı ve patognomonik olmayan belirtilerinin yanı sıra nadir görülmelerinden dolayı oldukça zor teşhis edilmektedirler ve çok belirgin olmadıkça gözden kaçabilmektedirler. Anahtar Kelimeler: İnsülinom, pankteatik islet hücre tümörü, kompleks kısmi nöbet, davranışsal değişimler, kişilik bozuklukları.

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“…On the other hand, the glucagon test has long been known to be a provocative test in insulinoma patients: glucagon may trigger severe hypoglycaemia related to insulin secretion in insulinoma patients. This provocative test was found to be helpful for the diagnosis of insulinoma in patients with a negative fast test (Wiesli et al 2004b;Soh & Kek 2010).…”

Section: Glucagon Testmentioning

confidence: 98%

“…Placzowski et al reported 100% sensitivity and specificity for the diagnosis of insulinoma with beta-hydroxy-butyrate levels of 2.7 mmol/L or less during a fast test with concomitant plasma glucose concentrations below 0.6 g/L or below 0.5 g/L (Placzkowski et al 2009), but the results are not detailed. There are two case reports of insulinoma patients with false negative results of beta-hydroxy-butyrate levels: an 80-year-old female patient with plasma glucose concentrations of 0.48 g/L (2.7 mmol/L), serum C-peptide of 0.93 ng/mL (0.31 nmol/L) and beta-hydroxy-butyrate levels of 3.0 mmol/L after 72 hours of fast (Wiesli et al 2004b) and a 49-year-old man with plasma glucose concentrations of 0.32 g/L, serum C-peptide levels of 1.2 ng/mL, and betahydroxy-butyrate levels of 3.2 mmol/L (Soh & Kek 2010). Among our patients (Vezzosi et al 2007), one patient with a malignant insulinoma was found to have, during a fast test, plasma glucose concentrations of 0.36 g/L, serum C-peptide levels of 1.7 ng/mL, plasma proinsulin levels of 37 pmol/L (which led to the unequivocal diagnosis of inappropriate insulin secretion) and plasma beta-hydroxy-butyrate levels of 3.8 mmol/L.…”

Section: Beta-hydroxy-butyratementioning

confidence: 99%