Surgery Versus Snacking as Treatment of Insulinoma

Abstract

From the Department of Internal Medicine, University of Oklahoma, Tulsa. A 19-year-old man presented with a generalized tonic-clonic seizure and serum glucose of 19 mg/dL. The seizure was aborted with dextrose and resolution of hypoglycemia. The patient had begun experiencing episodes of lightheadedness, fatigue, and seizures at age 16. Physicians in Mexico attributed his symptoms to poor nutritional intake and instructed him to increase his meal frequency and intake of soda and candy. He remained symptomatic for 3 years despite consuming 8 to 12 sodas daily supplemented by candy bars. Laboratory testing showed elevated serum insulin (200.8 mlU/mL), C-peptide (13.7 ng/ mL), proinsulin (296 pmol/L), and betahydroxybutyrate (0.3 mg/dL) levels. The sulfonylurea panel results were negative, and the serum calcium, intact parathyroid hormone, corticotropin, thyrotropin, and cortisol levels were within the normal range. A 72-hour fast revealed a glucose level of 30 mg/dL at 5 hours without neuroglycopenic or adrenergic symptoms. Computed tomography of the abdomen