Insulinoma as a rare cause of hypoglycemia in childhood: case report

INTRODUCTION: Insulinoma is a neuroendocrine tumor that originates in pancreatic beta cells, resulting in severe and frequent preprandial hypoglycemia. The diagnosis should be considered in the presence of the Whipple triad (present in 75% of cases) and confirmed through the demonstration of high insulin levels associated with low serum glucose levels. Treatment is surgical and, in most cases, curative. CASE REPORT: Girl, 10-years-old, hospitalized for the investigation of possible refractory epilepsy with predominant morning seizures, which started 6 months prior to her admission. A pediatric endocrinology evaluation was requested, as hypoglycemia was evidenced during the occurrence of seizures, which improved after intravenous glucose infusion. During the tests of the critical sample, hyperinsulinism associated with hypoglycemia was revealed. The diagnosis of insulinoma was therefore considered and then confirmed, after an intrapancreatic lesion showed up on the imaging tests. She was referred for surgical excision and had good evolution after tumor enucleation. COMMENTS: Insulinoma is a rare neuroendocrine tumor in the pediatric group. It may initially present itself as a hard-to-control convulsive condition, accompanied by behavioral changes and developmental delay, which often leads to misdiagnosis. Thus, early diagnosis and intervention are important since they reduce the morbidity and mortality of affected individuals. The patient did not present neurological sequelae and had a favorable post-surgical evolution, without recurrence of symptoms or further episodes of hyperglycemia.