Insulinoma- Rare pancreatic tumor

Abstract

Insulinoma is hormone producing neuroendocrine pancreatic tumor. Insulinoma is a type of functional neuroendocrine tumor characterized by hypersecretion of insulin, causing hypoglycemia. It typically presents as a solitary benign tumor but can be associated with multiple endocrine neoplasia type 1 (MEN1). Patients with insulinoma have hypoglycemic episodes, more characteristically as fasting hypoglycemia.46 yrs. old male having recurrent episode of Syncopal attack, sweating, excessive thrust, and weakness last 3 to 4 yrs. His blood sugar level was always below normal range at time of attack. No H/O diabetes, Hyper tension or any other chronic illness.On detail examination and investigation, we found that his blood sugar level fall 01 hrs. After food intake and blood sugar fasting and post prandial (F=46 mg/dl & PP= 180 mg/dl) is impaired. C Peptide level, serum insulin level is high. MRI shows growth near head of pancreas.Partial pancreatectomy done and sample send for histopathological examination which shows well differentiated pancreatic neuroendocrine tumor with no lymph node involvement and congested spleen.The Whipple triad, named after the American surgeon Allen O. Whipple (1881-1963), is the diagnostic hallmark establishing the existence of a hypoglycemic disorder and has the following 3 features: (1) symptoms, signs, or both consistent with hypoglycemia; (2) low plasma glucose measured at the time of the symptoms and signs; and (3) relief of symptoms and signs when the glucose is raised to a normal level (2, 3). Insulinoma is usually diagnosed by biochemical testing. Surgical resection is the preferred treatment choice.