Insulinoma Case Admitted with Reactive Hypoglycemia Symptoms

Author(s): Nizameddin Koca*, Soner Cander, Ozen Oz Gul, Nesrin Uğraş

Journal Name: Current Diabetes Reviews

Volume 16 , Issue 7 , 2020

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Aim: To present an insulinoma case with post-prandial hypoglycemic symptoms associated with glucose inducible endogenous hyperinsulinemia.

Case: A 52-year-old female patient was evaluated for hypoglycemic symptoms especially those occuring within 3 hours after consuming sugary foods. These symptoms were persistent for a year and a half. She was diagnosed with reactive (post-prandial) syndrome and followed a recommended diet and was given acarbose but there was no improvement. The results suggested post-prandial endogenous hyperinsulinemia related hypoglycemia. Multiphasic computerized tomography revealed an 11x15x12 mm size mass lesion, anteriorly in the head and uncinate process of the pancreas and then the patients were treated surgically with pancreatic enucleation and cured.

Conclusion: Distinguishing post-prandial syndrome by careful history and clinical evaluation in patients with postprandial symptoms is of great importance in terms of cost-effectivity. However, it should not be forgotten that although organic pathologies are mostly presented with fasting hypoglycemia, they may also cause post-prandial symptoms. Severity and progression of the symptoms that point to neuroglycopenia is important, and in this condition the most convenient clinical approach to the patient should be performed with careful and appropriate assessment steps.

Keywords: Insulinoma, reactive hypoglycemia, post-prandial hypoglycemia, hyperinsulinemia, hypothyroidism, diabetes.

Service FJ, McMahon MM, O’Brien PC, Ballard DJ. Functioning insulinoma--incidence, recurrence, and long-term survival of patients: a 60-year study. Mayo Clin Proc 1991; 66(7): 711-9.
[] [PMID: 1677058]
Cander S, Gül OÖ, Yıldırım N, Unal OK, Saraydaroğlu O, Imamoğlu S. A rare cause of hypoglycemia in a type 2 diabetic patient: insulinoma. J Diabetes Complications 2012; 26(1): 65-7.
[] [PMID: 22401876]
Gül ÖÖ, et al. Clinical Management of Insulinomas: A Single Institution’s Experience. Turkish Journal of Endocrinology and Metabolism 2014; 18(3): 79-83.
Cander S, Gul OO, Yildirim-Eryilmaz N, Ugras N, Erturk E, Ersoy C. Adult Nesidioblastosis, Diagnostic Value of the Selective Arterial Calcium Stimulation Test and Perfusion Computed Tomography. A Case Report. Acta Endocrinol (Bucur) 2015; 11(1): 85-92.
Cryer PE, Axelrod L, Grossman AB, et al. Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2009; 94(3): 709-28.
[] [PMID: 19088155]
Galati SJ, Rayfield EJ. Approach to the patient with postprandial hypoglycemia. Endocr Pract 2014; 20(4): 331-40.
[] [PMID: 24246338]
Escalada FJ, Laguna S, Botella S. Postprandial reactive hypoglycemia: myth or reality? Avances en Diabetologia 2009; 25: 287-92.
Ritz P, Hanaire H. Post-bypass hypoglycaemia: a review of current findings. Diabetes Metab 2011; 37(4): 274-81.
[] [PMID: 21676638]
Placzkowski KA, Vella A, Thompson GB, et al. Secular trends in the presentation and management of functioning insulinoma at the Mayo Clinic, 1987-2007. J Clin Endocrinol Metab 2009; 94(4): 1069-73.
[] [PMID: 19141587]
Kikuchi T, Chujo D, Takahashi K, et al. Insulinoma Presenting with Reactive Hypoglycemia: Evaluating the Effect of Tumor Resection via Continuous Glucose Monitoring. Intern Med 2017; 56(22): 3067-71.
[] [PMID: 28943561]
Straussman S, Levitsky LL. Neonatal hypoglycemia. Curr Opin Endocrinol Diabetes Obes 2010; 17(1): 20-4.
[] [PMID: 19952738]
Kaczirek K, Niederle B. Nesidioblastosis: an old term and a new understanding. World J Surg 2004; 28(12): 1227-30.
[] [PMID: 15517495]
Kar P, Price P, Sawers S, Bhattacharya S, Reznek RH, Grossman AB. Insulinomas may present with normoglycemia after prolonged fasting but glucose-stimulated hypoglycemia. J Clin Endocrinol Metab 2006; 91(12): 4733-6.
[] [PMID: 17003090]
Vasan SK, Ramachandran P, Mathew M, Natraj CV, Antonisamy B, Thomas N. Post-absorptive glucose lowering in normal healthy individuals: an epidemiological observation. Diabetes Res Clin Pract 2014; 104(1): e5-7.
[] [PMID: 24565212]
Saddig C, Goretzki PE, Starke AA. Differentiation of insulin secretion patterns in insulinoma. World J Surg 2008; 32(5): 918-29.
[] [PMID: 18259806]
Iida K, Ohara T, Hino Y, Nobuhara M, Ishida J, Chihara K. Glucose-responsive insulinoma in a patient with postprandial hypoglycemia in the morning. Intern Med 2010; 49(19): 2123-7.
[] [PMID: 20930440]
Thompson SM, Vella A, Thompson GB, et al. Selective Arterial Calcium Stimulation With Hepatic Venous Sampling Differentiates Insulinoma From Nesidioblastosis. J Clin Endocrinol Metab 2015; 100(11): 4189-97.
[] [PMID: 26312578]
Guettier JM, Kam A, Chang R, et al. Localization of insulinomas to regions of the pancreas by intraarterial calcium stimulation: the NIH experience. J Clin Endocrinol Metab 2009; 94(4): 1074-80.
[] [PMID: 19190102]

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Article Details

Year: 2020
Page: [790 - 796]
Pages: 7
DOI: 10.2174/1573399815666190712200716
Price: $65

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