A case of insulinoma with non-alcoholic fatty liver disease: Roles of hyperphagia and hyperinsulinemia in pathogenesis of the disease

Abstract

Abstract. Nonalcoholic fatty liver disease (NAFLD) is a serious health-related condition all over the world; the number of patients is increasing in Asian countries including Japan. Better understanding of its pathophysiology is required to develop effective therapeutics, as patients may go on to develop non-alcoholic steatohepatitis and hepatocellular carcinomas. While NAFLD is believed to be associated with metabolic risk factors such as obesity, diabetes, and dyslipidemia, its etiology remains largely unknown and the development or co-existence of NAFLD in patients with insulinoma has not been investigated. A 33-year-old male with an insulinoma, who had been hypoglycemic during the previous four years, developed abnormally elevated levels of liver enzymes and histological fatty liver characteristic of NAFLD by the time of admission to our hospital for resection of an insulinoma. His medical records for the previous eight years revealed that his bodyweight had increased gradually from 60 kg to 71 kg for seven years and then acutely increased to 79 kg in the latest one-year period. This sudden increase was thought to be due to the patient's self-described overeating of fruits to forestall hypoglycemia. Fresh fruits are rich in fructose, and the patient's triglycerides, alanine and aspartate transaminases showed an acute increase in the previous one-year period. After resection of the insulinoma, the levels of these parameters all were mostly restored, which suggests that hyperinsulinemia and subsequent hyperphagia played a role in the development of NAFLD in this case. This is the first report of patient with NAFLD and an insulinoma.Key words: Insulinoma, Non-alcoholic fatty liver disease, Fibroscan, Fructose steatohepatitis and hepatocellular carcinomas [1][2]. While NAFLD is associated with metabolic risk factors such as obesity, diabetes, and dyslipidemia, its etiology remains largely unknown and the development or co-existence of NAFLD in patients with insulinoma has not been investigated [1][2][3][4]. Here we report a case of insulinoma with NAFLD, in which surgical resection of the tumor drastically improved NAFLD-related parameters and hypoglycemia. Case PresentationA 33-year-old male suspected of insulinoma was referred to Kansai Electric Power Hospital for surgical resection of the tumor. His fasting plasma glucose lev-

Insulinoma with a History of Epilepsy: Still a Possible Misleading Factor in the Early Diagnosis of Insulinoma

“…In addition, our case did not show any increased appetite or body weight gain, although these are also characteristic symptoms of insulinoma ( 16 , 21 ). AEDs can also cause a masking effect on hunger and weight gain, possibly through a reduced appetite ( 10 ).…”

Hypoglycemia Unawareness in Insulinoma Revealed with Flash Glucose Monitoring Systems

“…Previous studies have shown that the median time to a diagnosis is 24 months, with a range of up to 30 years (12). A delayed diagnosis of insulinoma can progressively induce coma or death (7,8,13) and remains a clinical issue (6,14).…”

Plant‐Based Foods and Their Bioactive Compounds on Fatty Liver Disease: Effects, Mechanisms, and Clinical Application

“…The intake of fructose is recognized as a risk factor for NAFLD, and some types of fruit are fructose-rich foods [187]. A case report of a 33-year-old male with insulinoma and hypoglycemia for 4 years showed that overeating of fruits, especially the fruits rich in fructose, might exacerbate histological changes of NAFLD [188]. Therefore, the dietary recommendations of fruit intake for the fatty liver population need to be considered thoroughly and carefully.…”