A case of malignant insulinoma responsive to somatostatin analogs treatment

Insulinoma as a cause of seizure-like activity and spontaneous hypoglycaemia

A woman in her 60s presented to our hospital with recurrent episodes of confusion and double vision with spontaneous recovery to baseline within 10 min. Her initial workup was unremarkable, and she was diagnosed with complex partial seizures and commenced on levetiracetam. The following week, she re-presented with a recurrence of her symptoms, associated with spontaneous hypoglycaemia, with blood glucose levels of 1.9 mmol/L. She was found to have endogenously elevated serum insulin and C peptide levels, which were concomitantly associated with hypoglycaemia. An initial diagnosis of insulinoma was made and she was commenced on diazoxide. MRI and endoscopic ultrasound revealed 16 mm insulinoma in her uncinate process. She underwent surgical resection and remained symptom free at follow-up. This case highlights the importance of blood glucose measurements in patients presenting with neuroglycopenic symptoms and outlines the workup and management of insulinoma.

Non-islet cell tumor hypoglycemia associated with Gastrointestinal Stromal Tumor: Case report and review of the literature

Non-islet cell tumor hypoglycemia is an uncommon paraneoplastic phenomenon commonly associated with tumors of mesenchymal origin like gastrointestinal stromal tumors (GIST). It causes the release of insulin-like growth factor type II. GIST are frequently asymptomatic but can present with vague symptoms such as gastrointestinal bleeding, gastric pain, anorexia, nausea, and vomiting. We present an interesting case of A 62-year-old male with GIST tumor admitted for refractory hypoglycemia found to have non-islet cell tumor hypoglycemia which is a relatively uncommon cause of hypoglycemia.

Refractory hypoglycemia induced by a duodenal wall gastrointestinal stromal tumor: A case report

Background

Tumor-associated hypoglycemia can be caused by non-islet cell tumors including gastrointestinal stromal tumor (GIST) which is a rare paraneoplastic syndrome that leads to the release of insulin-like growth factor-2 (IGF-2).

Case Presentation

We report the case of a 45-year old woman who was admitted to our hospital with refractory hypoglycemic episodes. We found normal serum insulin and c-peptide level and abdominal CT-scan showed a small duodenal wall lesion suggesting insulinoma. After tumor resection, hypoglycemia symptoms were recovered, but the pathological findings demonstrated the lesion was GIST.

Conclusion

In a small gastrointestinal lesion with hypoglycemic symptoms we should consider IGF-II secreting GIST in addition to insulinoma.

Successful surgical treatment of a patient with primary insulinoma of the liver

Insulinoma is the most frequent functional neuroendocrine tumor of the pancreas, which causes organic hyperinsulinism with severe hypoglycemia. There are no cases of primary insulinoma of the liver described. A 63-year-old female was admitted to our center presenting symptoms of severe hypoglycemia due to confirmed endogenic hyperinsulinism. None of the performed diagnostic procedures could reveal a pancreatic tumor. However, a pathologic mass in the sixth segment of the liver was detected. We performed arterial calcium stimulation that showed increased levels of insulin and c-peptide in almost all stimulated arteries. The highest and most prolonged peaks were detected at the points of the common hepatic artery and the right hepatic artery. After the surgical removal of the liver tumor, the blood glucose level was stabilized within the normal range. Post-operative pathomorphological investigation confirmed the diagnosis of a neuroendocrine tumor. The long-term survival results show correct treatment tactics without any signs of disease recurrence.