Abstract
Background. A 41-year-old Maltese woman with a 12-month history of severe, morning episodes of confusion, blurred vision and sweating was referred to a specialist center for evaluation of fasting hypoglycemia. She was not taking medication and did not report any prior personal or familial history of endocrinopathy or other relevant pathology.
Investigations. Measurement of plasma glucose, insulin, C-peptide, and β-hydroxybutyrate concentrations during a prolonged supervised fast; sulfonylurea screen; CT, MRI scan and endoscopic ultrasonography of the pancreas; calcium stimulation test; surgical exploration and intra-operative ultrasonography of the pancreas.
Diagnosis. Insulin-secreting lesion (insulinoma) in the tail of the pancreas.
Management. The tumor was resected with cure of symptoms.
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Acknowledgements
Written consent for publication was obtained from the patient. C.C. was on an elective placement in the Department funded by the Portuguese endocrinology society and the Study Association for Diabetes and Endocrinology of Almada. We thank Mr Satya Bhattacharya for his contribution to the clinical management of the patient.
Désirée Lie, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.
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Coelho, C., Druce, M. & Grossman, A. Diagnosis of insulinoma in a patient with hypoglycemia without obvious hyperinsulinemia. Nat Rev Endocrinol 5, 628–631 (2009). https://doi.org/10.1038/nrendo.2009.198
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DOI: https://doi.org/10.1038/nrendo.2009.198
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