Insulinoma masquerading as neurologic disease – Case report and review of the literature

Abstract

Introduction: Insulinomas are the most frequent cause of hypoglycemia in non-diabetic patients and the most common functional endocrine pancreatic tumors. Symptoms of hypoglycemia are nonspecific so the diagnosis may be challenging.
Case report: A 36-year-old male was admitted in the emergency room with hypoglycemia. The patient recalled symptoms of diaphoresis and blurred vision for the past 4 months, sometimes with loss of consciousness and incontinence of urinary sphincter. He was diagnosed with epilepsy and started on anticonvulsive drugs. These symptoms occurred before meals, were relieved with eating carbon hydrates and were associated with weight gain. Prolonged supervised fasting test was applied and led to symptomatic hypoglycemia with hyperinsulinemia. Abdominal magnetic resonance demonstrated a well-defined enhanced lesion in the pancreatic tail. Nodule enucleation was performed by laparoscopy and pathological examination was compatible with insulinoma. Shortly after surgical treatment, glucose levels increased to the normal range.
Conclusion: The diagnosis of insulinoma may be difficult due to its rarity and variable clinical presentation. Other diseases, such as neurologic, may be considered first, but it’s important to consider the diagnosis since chronic and severe hypoglycemia can be fatal and the surgery is usually curative.

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