Franciscan Health Olympia Fields, IL, United States
Navkiran Randhawa, DO1, Mahnoor Khan, DO2, Irshad Abida, MD1 1Franciscan St. James Hospital, Olympia Fields, IL; 2Franciscan Health, Olympia Fields, IL
Introduction: Insulinoma is a rare, neuroendocrine tumor with an annual incidence of four cases per million people in the general population. This tumor commonly presents in the fifth decade of life and has a higher incidence in females. Most patients present with symptomatic, hypoglycemic episodes that resolve with glucose administration.
Case Description/Methods: A 21-year-old African American male with no past medical history presented with seizure-like activity. He was found unresponsive with a blood glucose of 21 by EMS. He was given one Amp of D50 with subsequent improvement of his symptoms. Initial labs were remarkable for a glucose of 67 and he was started on continuous 5% dextrose water. His insulin level and c-peptide were normal. Screening was negative for exogenous insulin, sulfonylurea, alcohol or substance abuse.
A CT abdomen/chest and MRI abdomen/pelvis revealed innumerable enhancing round masses concerning for metastatic disease. Liver biopsy revealed a Grade 2, well differentiated neuroendocrine tumor while a 1.3 cm pancreatic insulinoma was seen on endoscopic ultrasound. He is currently scheduled to follow up with an oncologist for a Dotatate PET scan.
Discussion: Insulinomas present as a Whipple’s triad with hypoglycemia and neuroglycopenic symptoms that resolve with glucose. We present a young, African American male without any prior medical history who presented with a metastatic pancreatic insulinoma. This tumor can be misdiagnosed as a seizure disorder, syncopal episode, psychiatric syndrome or factitious hypoglycemia. Therefore, clinicians should consider the diagnosis of insulinoma in every patient presenting with hypoglycemia.
Navkiran Randhawa indicated no relevant financial relationships.
Mahnoor Khan indicated no relevant financial relationships.
Irshad Abida indicated no relevant financial relationships.
Navkiran Randhawa, DO1, Mahnoor Khan, DO2, Irshad Abida, MD1. P0111 - Not So Sweet After All: A Case of Metastatic Pancreatic Neuroendocrine Tumor in a Young Male, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.