Case Report: Insulinoma Presenting as Excessive Daytime Somnolence

Yu, Zhennan; Wang, Yongliang; Sun, Yaqi; Wang, Yumei; Tian, Yayun; Ma, Qinying; Fu, Ying Hui

doi:10.3389/fendo.2021.712392

Cited by 3 publications

(3 citation statements)

References 13 publications

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“…4) The primary symptom was recurrent seizures, leading to the initial diagnosis and treatment of a neurological disorder. These factors contributed to the initial misdiagnosis and delayed identification of the underlying cause of hypoglycemia [17].…”

Section: Discussionmentioning

confidence: 99%

Recurrent Hypoglycemia After Total Gastrectomy: A Case Report and Literature Analysis

Zhang,

Chen,

Wang

2024

Am J Case Rep

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Objective:Rare disease Background:Hypoglycemia is a common complication following total gastrectomy, primarily caused by dumping syndrome and severe malnutrition, with late dumping syndrome being particularly significant. However, for recurrent fasting hypoglycemia, the possibility of insulinoma should be considered. Hypoglycemia caused by insulinoma can lead to severe consequences, including seizures and even death. Thus, it is crucial to differentially diagnose hypoglycemia occurring after total gastrectomy. Case Report:In this report, we present the case of a 36-year-old Chinese woman who underwent total gastrectomy for gastric cancer and subsequently received chemotherapy. Four months after surgery, she began experiencing recurrent seizures, and multiple tests confirmed hypoglycemia. A series of laboratory and imaging examinations ultimately led to a diagnosis of insulinoma. After surgical resection of the tumor, the patient's hypoglycemic symptoms resolved, and pathology results confirmed an insulinoma. Conclusions:This case report highlights the rapid weight loss and severe hypoglycemia observed in a patient only 4 months after total gastrectomy for gastric cancer. Although dumping syndrome was initially suspected based on the clinical course, the final diagnosis turned out to be insulinoma. The case underscores the importance of comprehensive evaluation and appropriate diagnostic investigations for patients experiencing hypoglycemia after total gastrectomy. Furthermore, the case suggests that the increased levels of enteroglucagon following changes in the gastrointestinal tract resulting from total gastrectomy may promote the development of insulinomas. This case report also contributes to the existing literature regarding atypical presentations of insulinomas and their association with gastric resection.

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Section: Discussionmentioning

confidence: 99%

Recurrent Hypoglycemia After Total Gastrectomy: A Case Report and Literature Analysis

Zhang,

Chen,

Wang

2024

Am J Case Rep

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“…However, more than 90% of insulinomas have a diameter of <2 cm, and the sensitivity of US is low (23%–63%,), while CT is 40% to 73%. [3] The diagnosis of insulinoma by MRI is not as accurate as diagnosis by CT, and false-negative results are common. However, the invasive examination method of endoscopic US has an accuracy rate of 96.2%, and the accuracy rate can reach 91% when intraoperative US examination is combined with intraoperative palpation by surgeons.…”

Section: Discussionmentioning

confidence: 99%

“…Insulinoma can occur at any age, with a male-to-female ratio of 2:3, [3] while non-insulinoma pancreatogenous hypoglycemia syndrome (NIPH) is more common in the elderly population, and IAS usually occurs in people over 40 years old. There is no significant difference in the sex ratio between IAS and NIPH.…”

Section: Discussionmentioning

confidence: 99%

A review on nondiabetic hypoglycemia from various causes: Case series report

Gan,

Zhu,

Gao

et al. 2023

Medicine

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Rationale: Hypoglycemia is common in patients with glucose regulation disorders and related diabetic treatments but is rare in nondiabetic patients. Severe hypoglycemia can cause harm to patients’ cognition, consciousness, central nervous system, cardiovascular and cerebrovascular system, and even death. However, the most fundamental way to control hypoglycemia is to identify the cause and deal with the primary disease. This article introduces 3 cases of nondiabetic hypoglycemia with different causes, aiming to improve our understanding of nondiabetic hypoglycemia and improve the ability of early diagnosis and differential diagnosis. Patient concerns: Case 1 is a 19-year-old female with a history of recurrent coma, and magnetic resonance imaging and endoscopic ultrasound of the pancreas suggest insulinoma. Case 2 is a 74-year-old male with a history of viral hepatitis, and computerized tomography shows multiple nodules in the liver, which is diagnosed as liver cancer. Case 3 is a 39-year-old female with a history of taking methimazole, who tested positive for insulin antibodies, and was diagnosed with insulin autoimmune syndrome. Diagnosis: All 3 patients were diagnosed with nondiabetic hypoglycemia, but the causes varied, and included insulinoma, non-islet cell tumor-induced hypoglycemia, and insulin autoimmune syndrome. Interventions: Case 1 underwent pancreatic tail resection; case 2 refused anti-tumor treatment and received glucose injections for palliative treatment only; and case 3 stopped taking methimazole. Outcomes: After surgery, the blood sugar in case 1 returned to normal, and the blood sugar in case 2 was maintained at about 6.0 mmol/L. The symptoms of hypoglycemia gradually improved in case 3 after stopping the medication. Lessons: Non-diabetic hypoglycemia requires further examination to clarify the cause, and the correct differential diagnosis can provide timely and effective treatment, improving the patient’s prognosis.

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Insulinoma as a cause of seizure-like activity and spontaneous hypoglycaemia

2023

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A woman in her 60s presented to our hospital with recurrent episodes of confusion and double vision with spontaneous recovery to baseline within 10 min. Her initial workup was unremarkable, and she was diagnosed with complex partial seizures and commenced on levetiracetam. The following week, she re-presented with a recurrence of her symptoms, associated with spontaneous hypoglycaemia, with blood glucose levels of 1.9 mmol/L. She was found to have endogenously elevated serum insulin and C peptide levels, which were concomitantly associated with hypoglycaemia. An initial diagnosis of insulinoma was made and she was commenced on diazoxide. MRI and endoscopic ultrasound revealed 16 mm insulinoma in her uncinate process. She underwent surgical resection and remained symptom free at follow-up. This case highlights the importance of blood glucose measurements in patients presenting with neuroglycopenic symptoms and outlines the workup and management of insulinoma.

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Case Report: Insulinoma Presenting as Excessive Daytime Somnolence

Cited by 3 publications

References 13 publications

Recurrent Hypoglycemia After Total Gastrectomy: A Case Report and Literature Analysis

Recurrent Hypoglycemia After Total Gastrectomy: A Case Report and Literature Analysis

A review on nondiabetic hypoglycemia from various causes: Case series report

Insulinoma as a cause of seizure-like activity and spontaneous hypoglycaemia

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