Metastatic insulinoma presenting after bariatric surgery in a patient diagnosed with MEN1

Abstract

Insulinomas are uncommon neuroendocrine tumors and metastatic disease is extremely rare. We report a patient with metastatic insulinoma associated with multiple endocrine neoplasia type 1 presenting with hypoglycemia following sleeve gastrectomy. Potential causes of hypoglycemia include dumping syndrome, noninsulinoma pancreatogenous hypoglycemia syndrome, and rarely insulinoma. MEN1‐associated insulinomas have a higher recurrence rate.

Insulinoma After Bariatric Surgery: Tricks for Diagnosis and Therapeutic Approach

“…Insulin resistance caused by the obesity as well as lack of awareness of symptoms of hypoglycemia by the patients, may contribute to the delay in the identification of the insulinoma. Patients often fail to recognize autonomic warning symptoms and the hypoglycemia is only detected through the presence of neuroglycopenic symptoms delaying the diagnosis of the insulinoma for up to 5 years [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37].…”