Occult insulinoma after oesophagectomy for oesophageal cancer-diagnostic challenges

Authors

  • Marta Alexandre Silva Department of General Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal http://orcid.org/0000-0003-0868-7436
  • Maria João Amaral 1Department of General Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal 2Faculty of Medicine, University of Coimbra http://orcid.org/0000-0002-7494-3218
  • Pedro Pinto Department of General Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • Mónica Martins Department of General Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • Marco Serôdio 1Department of General Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal 2Faculty of Medicine, University of Coimbra
  • Dírcea Rodrigues Department of Endocrinology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • Dírcea Rodrigues Department of Endocrinology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • José Guilherme Tralhão 1Department of General Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal 2Faculty of Medicine, University of Coimbra 5Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra

DOI:

https://doi.org/10.18203/2349-2902.isj20215154

Keywords:

Oesophageal cancer, Dumping syndrome, Endogenous hyperinsulinemic Hypoglycaemia, Insulinoma

Abstract

Hypoglycaemia in the post-operative period is mainly iatrogenic (related to anti-hyperglycaemic drugs), but can be explained by an endogenous hyperinsulinemic state. In the context of previous gastrointestinal surgery, a form of dumping syndrome can mask hypoglycaemia from an underlying cause, such as an insulinoma. The authors present a clinical case of a male patient who underwent oesophageal surgery for an oesophago-gastric junction adenocarcinoma and developed hypoglycaemic symptoms in the post-operative period, caused by an undiagnosed insulinoma. This case report portraits the diagnostic investigation of a hypoglycaemia state in the post-operative period, narrowing to the workup of an endogenous hyperinsulinemic hypoglycaemia and provides a summary of insulinoma’s treatment. An insulinoma should always be considered in a patient with endogenous hyperinsulinemic hypoglycaemia, even with a history of oesophago-gastric surgery.

Author Biographies

Marta Alexandre Silva, Department of General Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

Department of General Surgery

Maria João Amaral, 1Department of General Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal 2Faculty of Medicine, University of Coimbra

Department of General Surgery

Pedro Pinto, Department of General Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

Department of General Surgery

Mónica Martins, Department of General Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

Department of General Surgery

Marco Serôdio, 1Department of General Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal 2Faculty of Medicine, University of Coimbra

Department of General Surgery

Dírcea Rodrigues, Department of Endocrinology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

Department of Pathology

Dírcea Rodrigues, Department of Endocrinology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

Department of Endocrinology

José Guilherme Tralhão, 1Department of General Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal 2Faculty of Medicine, University of Coimbra 5Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra

Department of General Surgery

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Published

2021-12-28

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Section

Case Reports