Abstract
Delayed diagnosis of insulinoma remains an intractable clinical challenge because the symptoms are in most cases misattributed to other disorders. In this study, a 64-year-old man presented with intermittent seizure episodes after being misdiagnosed with epilepsy and receiving anti-epileptic drugs for 4 years. During this period, the patient continued to suffer from repeated seizures. A starvation test, pancreatic enhancement CT, MRI scan, and pathological examination clinically diagnosed insulinoma, and the symptoms improved following surgical removal of the tumor. The appearance of unusual manifestations and insulinoma imaging makes it difficult to accurately diagnose the condition. This case emphasizes the need for careful reassessment of all atypical and refractory seizures for neurologists.
Highlights
Insulinoma is a very rare neuroendocrine tumor with a reported incidence of 0.5–5 per million person-years
We report a case of insulinoma with impaired consciousness and behavioral disorders, which resulted from hypoglycemia and which were misdiagnosed as complex partial seizures based on the normal fasting blood glucose and glycosylated hemoglobin levels prior to admission
We reported a case of insulinoma presenting as a refractory seizure disorder in adulthood
Summary
Insulinoma is a very rare neuroendocrine tumor with a reported incidence of 0.5–5 per million person-years. Complex partial seizures are characterized by an aura, impaired consciousness, automatisms, and sometimes psychopathology, known as temporal lobe seizures (TLE) or psychomotor seizures Sometimes they are confused with metabolic diseases, such as hypoglycemia (Graves et al, 2004). We report a case of insulinoma with impaired consciousness and behavioral disorders, which resulted from hypoglycemia and which were misdiagnosed as complex partial seizures based on the normal fasting blood glucose and glycosylated hemoglobin levels prior to admission. On the fifth day after admission, the finger prick test revealed a blood glucose level of 2.5 mmol/L before lunch, and this was lower than the normal value despite the patient not having any hypoglycemia-related symptoms, such as palpitations, sweating, and hunger. Following surgical removal of the tumor, the patient’s blood glucose level normalized, and no recurrence of seizures was noted
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