Where´s the Insulinoma? A clinical case report

• Autor(a) principal: Cavaco, Raquel
• Data de Publicação: 2009
• Outros Autores: Man, Márcia, Jordão, Alda, Raposo, J., Gorjão Clara, J.
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://revista.spmi.pt/index.php/rpmi/article/view/1382
• topic: insulinoma; hipoglicemia; hiperinsulinemia; neuroglicopenia; prova de jejum prolongado; arteriografia; enucleação; insulinoma; hypoglycaemia; hyperinsulinemia; neuroglicopenic symptoms; 72 – hours fast; arteriography; enucleation

The suspicion of insulinoma in an individual with adrenergic symptoms and / or neuroglycopenia must be the first concern in the differential diagnosis of hypoglycaemia. Insulinoma is the most frequent endocrine tumour of the pancreas and appears at any age, being more frequent between 40 and 60 years. The diagnosis is clinical and it can be difficult to make in the presence of doubtful symptoms of neuroglycopenia or adrenergic symptoms after meals. Whipple’s triad of - glycaemia below 50 mg/dl and symptoms / signs of hypoglycaemia that revert with administration of glucose - is strongly suggestive of insulinoma, and when associated with blood insulin inappropriately high, is diagnostic of insulinoma. The authors describe the case of a 58-year-old male patient, with a clinical picture characterized by multiple episodes of confusion, migraine, bewilderment, irritability, agitation and diaphoresis, of nearly 8 months duration. The complaints were not properly evaluated initially and the patient was treated with sedative drugs. A fasting glycaemia of 38 mg/dl made insulinoma a probable diagnosis, and this was confirmed by the 72 hour fast test. Difficulties arose, as usual, in locating the tumour with imaging methods (ultrasound, tomography scan, octreotide scan and endoscopic ultrasound) and only selective arteriography with catheterization of the branches of the coeliac artery revealed the tumour, located in the head of the pancreas. Surgical treatment consisted of tumour enucleation. The histological findings confirmed the diagnosis of benign insulinoma. The peculiarities of the diagnosis and particularities of the image studies in insulinoma are discussed.