Young Adult With Multivisceral Lesions and Hypoglycemia

Abstract

Gastroe A 28-year-old male patient presented with complaints of episodic sweating, palpitation and restlessness for 1 year. He had documented recurrent hypoglycemia which was relieved by consumption of sugars. There was a past history of craniotomy for cerebellar hemangioblastoma in 2009 and 2011. There was no significant family history. A general physical examination did not reveal any abnormality except for well healed craniotomy scars. The evocative testing for hypoglycemia revealed fasting blood sugar 40mg%, serum insulin levels 37 (range 1.9–23) mU/mL, C-peptide -6.68 (range 1.1-4.4) ng/mL. The patient was further investigated with contrast enhanced abdominal magnetic resonance imaging (MRI scan) (Figures A and B). The MRI scan depicts multiple simple cysts and/or serous cystadenomas of varying size in the pancreas. The left kidney has Bosniak 3 cystic lesions. There is a 3.1 2.8 cm heterogeneous solid tumor in the distal body pancreatic tail region.