An elusive cause of recurrent hypoglycemia: delayed diagnosis of insulinoma treated with curative distal pancreatectomy in a resource-limited setting.

Abstract

A 43-year-old woman presented with recurrent hypoglycemia and episodes of loss of consciousness. On admission, her blood glucose was 37 mg/dL (reference range: 70-99 mg/dl), with recovery after intravenous dextrose, fulfilling Whipple's triad. She had a two-year history of dizziness, fatigue, diaphoresis, and neuroglycopenic symptoms, often relieved by frequent soft drink intake, leading to weight gain. She was previously misdiagnosed with a neurologic disorder, resulting in delayed evaluation. Laboratory findings showed elevated serum insulin levels of 65 μU/mL (reference range: 2.6-24.9 μU/mL) during hypoglycemia. Contrast-enhanced CT identified a 1.7 × 1.3 cm mass in the pancreatic body without metastasis. The patient underwent distal pancreatectomy with splenectomy. Postoperatively, hypoglycemic episodes resolved completely. Histopathology confirmed insulinoma. This case highlights the importance of considering insulinoma in patients with recurrent hypoglycemia. Delayed diagnosis may occur due to nonspecific symptoms and misdiagnosis. Careful clinical assessment, basic biochemical testing, and imaging can facilitate timely diagnosis and effective surgical management in resource-limited settings.