Abstract
A very rare case of malignant insulinoma with hypogonadotropic hypogonadism was reported with a review of the literature. A 32-year-old man was admitted to the our hospital with the chief complaints of some episode of consciousness loss, incontinence of defecation and incomplete growth of the external genitalia. A biochemical examination revealed an extremely lower fasting blood glucose level in the presence of high blood insulin level, and some loading rests also showed findings compatible with the insulinoma. An insulinoma of the pancreatic body and tail was found by computed radiography, angiograpy of the abdomen and percutaneous transhepatic portal sampling, and following distal pancreatectomy was performed. Histological examination showed a low grade malignant feature, the tumor cells infiltrating into the vessels, so that malignant insulinoma was diagnosed. On the other hand, hypogonadotropic hypogonadism was also associated, which seemed to be due to gonadal dysfunction of the hypothalamic-pituitary system in the age of adolescence. It could be diagnosed by eunuchoidism, lower ranges of testosterone, LH and FSH values, no responsive to the LH-RH loading test, and a lack of organic lesion by the imaging. Now he is under the treatment with testosterone injection on ambulant basis.
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