Insulinoma in the Elderly: An Unusual Case in an 85-Year-Old Male

Introduction

The median age at diagnosis for insulinoma, a rare neuroendocrine tumor, is between 47 and 56 years old. We report an unusual case of insulinoma in a male patient who was 85 years old, above the typical age range for this illness.

Case description

The patient has a history of epilepsy and heart failure and presented with bilateral lower limb edema, cough, dyspnea, and orthopnea; the patient additionally had a temperature of 38.5°C and a low oxygen saturation level of 92%. Leukocytosis (WBC: 28.9 × 10⁹/L) and an increased C-reactive protein (CRP) level of 44.4 mg/L were found in the laboratory. Chest X-ray revealed cardiomegaly, pleural effusion, and chest infiltration. The patient had many hypoglycemic episodes during the hospital stay, with glucose levels ranging from 32 to 70 mg/dL. Dextrose was a successful treatment for these episodes. During one of the hypoglycemic episodes, laboratory tests revealed elevated C-peptide levels (14.6 ng/mL) and insulin levels (61.64 μIU/mL), which raised the possibility of insulinoma. An insulinoma-like 3.5 cm well-defined, rounded, hypervascular pancreatic lesion with early arterial enhancement was discovered during a multiphasic CT scan of the abdomen and pelvis using IV contrast. Bilateral pleural effusion and right lower lobe pneumonia were among the other CT findings.

Discussion

This case highlights the challenges and treatment of hypoglycemia in older individuals with complicated medical issues and how crucial it is to take uncommon causes like insulinoma into account.