Multiple episodes of hypoglycemia secondary to an insulinoma: case report
DOI:
https://doi.org/10.18203/2349-2902.isj20232837Keywords:
Insulinoma, Neuroendocrine tumor, Hypoglycemia, LaparoscopyAbstract
Within the group of pancreatic neuroendocrine tumors, insulinomas are the most frequent functioning tumors, representing 42% with an annual incidence of 0.4 cases per 100,000 inhabitants and exhibiting poor survival of less than 5 years. We report the case of a 57-year-old male with episodes of hypoglycemia of one year of evolution. Abdominal computed tomography reported a 3.5×3.6 cm mass in the neck of the pancreas. Surgery is the mainstay of treatment for insulinomas. Different studies have shown that the presence of these tumors is more frequent in patients undergoing post-mortem examinations. Diagnosis is usually late due to non-specific symptoms and is clinically based on the "Whipple's triad", as well as imaging and laboratory studies. Surgery is the mainstay of treatment for insulinomas. The minimally invasive procedure is an effective modality due to its benefits, however, it continues to be below conventional surgical management. In addition, the study of an intraoperative ultrasound helps to preserve the largest viable pancreatic tissue to avoid later complications.
References
Hallet J, Law CHL, Cukier M, Saskin R, Liu N, Singh S. Exploring the rising incidence of neuroendocrine tumors: a population-based analysis of epidemiology, metastatic presentation, and outcomes. Cancer. 2015;121(4):589-97.
Yao JC, Hassan M, Phan A, Dagohoy C, Leary C, Mares JE, et al. One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol. 2008;26(18):3063-72.
Okabayashi T, Shima Y, Sumiyoshi T, Kozuki A, Ito S, Ogawa Y, et al. Diagnosis and management of insulinoma. World J Gastroenterol. 2013;19(6):829-37.
Grimelius L, Hultquist GT, Stenkvist B. Cytological differentiation of asymptomatic pancreatic islet cell tumours in autopsy material. Virchows Arch A Pathol Anat Histol. 1975;365(4):275-88.
Kimura W, Kuroda A, Morioka Y. Clinical pathology of endocrine tumors of the pancreas. Analysis of autopsy cases. Dig Dis Sci. 1991;36(7):933-42.
Lawrence B, Gustafsson BI, Chan A, Svejda B, Kidd M, Modlin IM. The epidemiology of gastroenteropancreatic neuroendocrine tumors. Endocrinol Metab Clin North Am. 2011;40(1):1-18.
Zhang X, Jia H, Li F, Fang C, Zhen J, He Q, et al. Ectopic insulinoma diagnosed by 68Ga-Exendin-4 PET/CT: A case report and review of literature. Medicine. 2021;100(13):e25076.
Klimstra DS. Nonductal neoplasms of the pancreas. Mod Pathol. 2007;20(S1):94-112.
Shin JJ, Gorden P, Libutti SK. Insulinoma: pathophysiology, localization and management. Future Oncol. 2010;6(2):229-37.
Mahdi M, Almehman B, Nassan S, Binyahib S. Pancreatic insulinoma causing hypoglycemic episodes. J Pediatr Surg Case Rep. 2020;57(101466):101466.
Mittendorf EA, Liu Y-C, McHenry CR. Giant insulinoma: case report and review of the literature. J Clin Endocrinol Metab. 2005;90(1):575-80.
Giannis D, Moris D, Karachaliou GS, Tsilimigras D, Karaolanis G, Papalampros A, et al. Insulinomas: from diagnosis to treatment. A review of the literature. J BUON. 2020;25(3):1302-14.
McAuley G, Delaney H, Colville J, Lyburn I, Worsley D, Govender P, et al. Multimodality preoperative imaging of pancreatic insulinomas. Clin Radiol. 2005;60(10):1039-50.
Gutelius BJ, Korytkowski MT, Carty SE, Hamad GG. Diagnosis and minimally invasive resection of an insulinoma: report of an unusual case and review of the literature. Am Surg. 2007;73(5):520-4.
Guettier J-M, Lungu A, Goodling A, Cochran C, Gorden P. The role of proinsulin and insulin in the diagnosis of insulinoma: a critical evaluation of the Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013;98(12):4752-8.
Mehrabi A, Fischer L, Hafezi M, Dirlewanger A, Grenacher L, Diener MK, et al. A systematic review of localization, surgical treatment options, and outcome of insulinoma. Pancreas. 2014;43(5):675-86.
Navarro-Chavez H, Garza-Vega J, Segura-Ibarra V, Frausto-Alejos M, Flores-Villalba E. Ninety-one-year-old female with severe hypoglycemic events secondary to an insulinoma: A case report and review of literature. Rev Med UAS. 2022;12(1):49-55.
Mahdi M, Almehman B, Nassan S, Binyahib S. Pancreatic insulinoma causing hypoglycemic episodes. J Pediatr Surg Case Rep 2020;57(101466):101466.
Mittendorf EA, Liu Y-C, McHenry CR. Giant insulinoma: case report and review of the literature. J Clin Endocrinol Metab 2005;90(1):575–580.
Giannis D, Moris D, Karachaliou GS, Tsilimigras D, Karaolanis G, Papalampros A, et al. Insulinomas: from diagnosis to treatment. A review of the literature. J BUON 2020;25(3):1302–1314.
McAuley G, Delaney H, Colville J, Lyburn I, Worsley D, Govender P, et al. Multimodality preoperative imaging of pancreatic insulinomas. Clin Radiol 2005;60(10):1039–1050.
Gutelius BJ, Korytkowski MT, Carty SE, Hamad GG. Diagnosis and minimally invasive resection of an insulinoma: report of an unusual case and review of the literature. Am Surg 2007;73(5):520–524.
Guettier J-M, Lungu A, Goodling A, Cochran C, Gorden P. The role of proinsulin and insulin in the diagnosis of insulinoma: a critical evaluation of the Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2013;98(12):4752–4758.
Mehrabi A, Fischer L, Hafezi M, Dirlewanger A, Grenacher L, Diener MK, et al. A systematic review of localization, surgical treatment options, and outcome of insulinoma. Pancreas 2014;43(5):675–686.
Navarro-Chavez H, Garza-Vega J, Segura-Ibarra V, Frausto-Alejos M, Flores-Villalba E. Ninety-one-year-old female with severe hypoglycemic events secondary to an insulinoma: A case report and review of literature. Rev Med UAS 2022;12(1):49-55.
