Uncommon Manifestation of Hypoglycemia in a Patient with Insulinoma – A Case Report

Abstract Insulinoma are insulin-secreting tumors of pancreatic origin that generates hypoglycemia by excessive secretion of insulin. Insulinoma is a rare disease ant the most tumors are benign, solitary and occur at intrapancreatic sites. Case report. A 42-year old Caucasian women was hospitalized at the “Prof. N.C. Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases Bucharest in April 2019 after an episode of hypoglycaemia remitted after intravenous glucose administration. Patient accused for about two weeks anxiety phenomena. At the time of admission in the hospital the patient was conscious in a good general condition. Paraclinical investigations revealed basal blood glucose 29 mg/dl, fasting insulin serum 87.7 µU/ml and pancreatic C-peptide-7.90 ng/ml. During hospitalization under strict glycaemic monitoring, the patient presented frequent asymptomatic hypoglycemic episodes that was remitted after intravenous glucose administration. Nuclear magnetic resonance highlighted a nodular lesion of the pancreas and in May 2019 the tumor resection was practiced. After surgery the blood glucose ranged between 86 mg/dl and 116 mg/dl. To mention that patient has a family history of diabetes and she’s obese. Conclusion. This case suggests that lack symptoms of hypoglycaemia may be present in patients with insulinoma. Diagnostic of insulinoma requires high clinical suspicions, accurate biochemical investigations and imaging techniques for the localization of the tumor and may represent a challenge in certain situations.