Abstract
A 56-year-old woman presented to our clinic for recurrent hypoglycemia after undergoing resection of an incidentally discovered nonfunctional pancreatic endocrine tumor 6 years ago. She underwent a distal pancreatectomy and splenectomy, after which she developed diabetes and was placed on an insulin pump. Pathology showed a pancreatic endocrine neoplasm with negative islet hormone immunostains. Two years later, computed tomography scan of the abdomen showed multiple liver lesions. Biopsy of a liver lesion showed a well-differentiated neuroendocrine neoplasm, consistent with pancreatic origin. Six years later, she presented to clinic with 1.5 years of recurrent hypoglycemia. Laboratory results showed elevated proinsulin, insulin levels, and c-peptide levels during a hypoglycemic episode. Computed tomography scan of the abdomen redemonstrated multiple liver lesions. Repeated transarterial catheter chemoembolization and microwave thermal ablation controlled hypoglycemia. The unusual features of interest of this case include the transformation of nonfunctioning pancreatic endocrine tumor to a metastatic insulinoma and the occurrence of atrial flutter after octreotide for treatment.
Highlights
Hypoglycemia was recognized as early as the 19th century, hyperinsulinism was suspected to be the cause of hypoglycemia in nondiabetic patients.[1]
The patient was a surgeon with an 18-month history of severe hypoglycemia; exploratory laparotomy revealed an unresectable insulinoma with hepatic metastases
We report a woman with a nonfunctional pancreatic neuroendocrine tumor that transformed into a functional pancreatic endocrine tumor, a metastatic insulinoma
Summary
Hypoglycemia was recognized as early as the 19th century, hyperinsulinism was suspected to be the cause of hypoglycemia in nondiabetic patients.[1]. In 1927, Wilder reported the first case of an insulin-secreting tumor.[3,4] The patient was a surgeon with an 18-month history of severe hypoglycemia; exploratory laparotomy revealed an unresectable insulinoma with hepatic metastases. The patient died 1 month after surgery.[4] Wilder and his colleagues tested the idea that the tumor secreted insulin by extracting the patient’s tumor and administering it to rabbits. Their findings demonstrated that tumor extracts produced hypoglycemia and introduced the concept of an insulinoma.[4] it was not until 1929 that Roscoe Graham performed the first surgical resection of an insulinoma, relieving symptoms of hypoglycemia.[3,5]. We report a woman with a nonfunctional pancreatic neuroendocrine tumor that transformed into a functional pancreatic endocrine tumor, a metastatic insulinoma
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