Insulinoma presenting as refractory seizure disorder

Abstract

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.