P0111 - Not So Sweet After All: A Case of Metastatic Pancreatic Neuroendocrine Tumor in a Young Male

Navkiran Randhawa, DO¹, Mahnoor Khan, DO², Irshad Abida, MD^1
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.


Disclosures:


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.