Insulinoma-related Endogenous Hypoglycaemia with a Negative Fasting Test: A Case Report and Literature Review

Prieto-Saldarriaga, Carolina; Builes, Carlos; Arango-Saldarriaga, Clara Maria; Manotas-Echeverry, Cindy; Cadavid, Juan Camilo Pérez; Álvarez-Payares, José C; Arrieta, Luis Antonio Rodríguez

doi:10.12890/2022_003484

Cited by 3 publications

(2 citation statements)

References 15 publications

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“…are useful ion confirming the diagnosis. 4,5 The definitive management of insulinoma is surgical removal of the tumour. Diazoxide, somatostatin, phenytoin, glucocorticoids along with frequent feeds are medical management options for symptomatic relief in patients who are unfit for undergoing definitive surgery or waiting for planned surgery.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic challenges in surgical enucleation of pancreatic insulinoma

Deb,

Ahmed,

Bhattacharyya

2023

IJCA

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Insulinoma is a very rare tumour occurring in 1-4 persons per million per year. It is a functional endocrine tumour of the pancreas characterized by repeated attacks of hypoglycaemia presenting as adrenergic or neuroglycopenic symptoms. Surgical management of insulinoma is the mainstay of treatment which can be done by either laparoscopic or open approach. There is occurrence of rapid and wide fluctuations of blood glucose levels in the intraoperative as well as perioperative period. Intraoperative hypoglycaemia is critical due to masking of symptoms by the effect of anaesthesia and if not detected and treated promptly may lead to permanent neurological insult. We here-in describe the challenges of anaesthetic management in a case of functional pancreatic insulinoma undergoing open surgical enucleation with the help of intraoperative ultrasonography.

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Section: Discussionmentioning

confidence: 99%

Anaesthetic challenges in surgical enucleation of pancreatic insulinoma

Deb,

Ahmed,

Bhattacharyya

2023

IJCA

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“…In particular, the wide range of symptoms and complaints and the diverse constellations of laboratory ndings and clinical situations mean that correct diagnosis and subsequent treatment can sometimes take a very long time [22]. There are many "atypical" case reports documenting the di culties in making a correct diagnosis [23][24][25].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous hypoglycemia: Should we mind the gap? Long-term follow-up of healthy people who met Whipple´s Triad

Adelmeyer

Schauer

Kann

2023

Preprint

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Context: Patients discharged as “healthy” with the symptom of spontaneous hypoglycemia need more attention.Objective Characterization and long-term follow-up of these patientsMethods Retrospective analysis and questionnaire follow-upSetting: Center for Endocrinology, Diabetology and Osteology at the University Hospital Marburg, Inpatient DepartmentPatients: All patients who presented to our center for the 72-hour fast between 2005 and 2018 and were discharged without an internal medicine diagnosis were included.Interventions: Survey by questionnaireMain outcome measures: Patient-reported information about current symptoms compared to original symptoms, diagnosis of insulinoma or diabetes mellitus during follow-up, matched with primary care physician data, metabolic and biometric data such as body mass index (BMI), homeostasis model assessment for insulin resistance (HOMA IR), insulin sensitivity Matsuda Index (ISI-M) and area under the curveResults A total of 41 data sets were evaluated at baseline and 38 patients were followed for an average of approximately 10 years. 61% of respondents still reported the same symptoms as at baseline. No insulinoma was missed in these patients. Only two of the 38 patients developed diabetes mellitus.Conclusion The high percentage of patients who are discharged as "healthy" and still have symptoms after many years is disturbing. It is possible that the symptoms are not due to low blood glucose. We urge caution with the term "healthy". In addition, more research should be done on this topic.

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Spontaneous hypoglycemia: should we mind the gap? Long-term follow-up of healthy people who met Whipple’s triad criteria

Adelmeyer,

Schauer,

Kann

2024

Hormones

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Context Patients discharged as “healthy” with the symptoms of spontaneous hypoglycemia, commonly known as Whipple’s triad, need more attention. Objective Characterization and long-term follow-up of symptom development in patients with spontaneous hypoglycemia discharged as “healthy”. The objective was to ascertain whether any conditions related to the symptoms were diagnosed during the follow-up period. Methods Retrospective analysis of patient data and evaluation of a specific questionnaire on the development of symptoms of spontaneous hypoglycemia. In addition, patient questionnaires were evaluated and primary care physicians were asked about possible diseases not recorded at baseline that occurred during the follow-up period. Setting Center for Endocrinology, Diabetology, and Osteology at the University Hospital Marburg, Inpatient Department, Germany. Patients All patients who presented to our center for the 72-hour fast between 2005 and 2018 and were discharged without an internal medicine diagnosis were included. Interventions Survey by questionnaire, via telephone interview. Main outcome measures Patient-reported information on current symptoms compared to original symptoms, diagnosis of insulinoma or diabetes mellitus during follow-up, matched with primary care physician data, and metabolic and biometric data such as body mass index (BMI), homeostasis model assessment for insulin resistance (HOMA IR), insulin sensitivity Matsuda Index (ISI-M), and area under the curve. Results A total of 41 datasets were evaluated at baseline and 38 patients were followed for an average of approximately 10 years. In total, 61% of respondents still reported the same symptoms as at baseline. No insulinoma was missed in these patients. Only two of the 38 patients developed diabetes mellitus. Conclusion The high percentage of patients who are discharged as “healthy” and still have symptoms after many years is disturbing. It is possible that the symptoms are not due to low blood glucose. We urge caution with use of the term “healthy”. We advocate a multidisciplinary therapeutic approach after an organic cause of hypoglycemia has been ruled out. Psychosomatic treatment seems to be useful. In addition, more research should be conducted on this topic.

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Insulinoma-related Endogenous Hypoglycaemia with a Negative Fasting Test: A Case Report and Literature Review

Abstract: We present the case of a patient with a history of symptomatic hypoglycaemic episodes and a negative 72-hour fasting test with histological confirmation of insulinoma. A literature review of hyperinsulinaemic hypoglycaemia with a negative fasting test was performed.

Cited by 3 publications

References 15 publications

Anaesthetic challenges in surgical enucleation of pancreatic insulinoma

Anaesthetic challenges in surgical enucleation of pancreatic insulinoma

Spontaneous hypoglycemia: Should we mind the gap? Long-term follow-up of healthy people who met Whipple´s Triad

Spontaneous hypoglycemia: should we mind the gap? Long-term follow-up of healthy people who met Whipple’s triad criteria

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