The Occult Insulinoma Was Localized Using Endoscopic Ultrasound Guidance: A Case Report

IF 0.6 Q3 MEDICINE, GENERAL & INTERNAL

Clinical Case Reports Pub Date : 2025-02-10 DOI:10.1002/ccr3.9634

Zhongqiu Guo, Yanrong Chen, Ronghuo Liu, Yuhua Chen

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Abstract

Insulinomas are the primary etiology of endogenous hyperinsulinemic hypoglycemia, which often manifest with Whipple’s triad and neuroglycopenic symptoms. Given the diverse clinical manifestation and subtle onset of insulinomas generally in a small size, detecting a minority of these generally small tumors can be challenging. We reported a case of a 44-year-old female patient with recurrent hypoglycemia accompanied by hyperinsulinemia, and the conventional imaging revealed no abnormality. With the aid of endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB), the insulinoma was precisely diagnosed and localized, and successfully excised via operation. The patient’s hyperinsulinemia and hypoglycemic episodes were relieved significantly after surgery. The application of EUS-FNAB notably enhances the diagnostic accuracy for occult insulinomas, thereby informing appropriate surgical management. Herein, we advocate for invasive EUS examination in patients exhibiting strong clinical and laboratory indicators of insulinoma, even when conventional imaging results are negative.

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内镜超声引导下隐匿性胰岛素瘤定位1例

胰岛素瘤是内源性高胰岛素血症性低血糖的主要病因，通常表现为惠普尔三联征和神经性低血糖症状。由于胰岛素瘤的临床表现多样且发病微妙，通常体积较小，因此检测出这些通常较小的肿瘤中的少数可能具有挑战性。我们报告一例44岁女性反复低血糖伴高胰岛素血症患者，常规影像学检查未见异常。超声内镜引导下细针穿刺活检（EUS-FNAB）准确诊断并定位胰岛素瘤，成功手术切除。术后患者高胰岛素血症和低血糖发作明显缓解。EUS-FNAB的应用显著提高了对隐匿性胰岛素瘤的诊断准确性，从而提示适当的手术处理。在此，我们提倡对表现出强烈的胰岛素瘤临床和实验室指标的患者进行有创性EUS检查，即使常规影像学结果为阴性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Case Reports MEDICINE, GENERAL & INTERNAL-

自引率

14.30%

发文量

1268

审稿时长

13 weeks

期刊介绍： Clinical Case Reports is different from other case report journals. Our aim is to directly improve global health and increase clinical understanding using case reports to convey important best practice information. We welcome case reports from all areas of Medicine, Nursing, Dentistry, and Veterinary Science and may include: -Any clinical case or procedure which illustrates an important best practice teaching message -Any clinical case or procedure which illustrates the appropriate use of an important clinical guideline or systematic review. As well as: -The management of novel or very uncommon diseases -A common disease presenting in an uncommon way -An uncommon disease masquerading as something more common -Cases which expand understanding of disease pathogenesis -Cases where the teaching point is based on an error -Cases which allow us to re-think established medical lore -Unreported adverse effects of interventions (drug, procedural, or other).