Hypoglycaemia in an adult male: A surprising finding in pursuit of insulinoma

A 50-year-old man who had suffered several episodes of early morning sweats and tremors was diagnosed as having hyperinsulinaemic hypoglycaemia. Cross-sectional imaging and endoscopic ultrasound revealed no pancreatic lesion. A selective intra-arterial calcium infusion study showed a two-fold increa...

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Bibliographic Details
Published in:The surgeon (Edinburgh) 2008-02, Vol.6 (1), p.57-60
Main Authors: Geraghty, M, Draman, M, Moran, D, Muldoon, C, Reynolds, J.V, Cullen, M.J
Format: Article
Language:English
Subjects:
adult
Diagnosis, Differential
Endosonography
Humans
hyperinsulinaemic hypoglycaemia
Hyperinsulinism - diagnosis
Hypoglycemia - diagnosis
Insulinoma - diagnosis
islet cell hyperplasia
Magnetic Resonance Imaging
Male
Middle Aged
Nesidioblastosis - diagnosis
pancreas
Pancreatic Neoplasms - diagnosis
Surgery
Tomography, X-Ray Computed
Ultrasonography, Interventional
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Summary:A 50-year-old man who had suffered several episodes of early morning sweats and tremors was diagnosed as having hyperinsulinaemic hypoglycaemia. Cross-sectional imaging and endoscopic ultrasound revealed no pancreatic lesion. A selective intra-arterial calcium infusion study showed a two-fold increase of insulin secretion after infusion of the splenic and superior mesenteric arteries. Laparotomy was performed, no lesion was identified after full mobilisation ofthe pancreas, and nothing was evident with intra-operative ultrasound. A distal pancreatectomy was performed. Microscopically, the pancreas exhibited diffuse islet cell hyperplasia consistent with nesidioblastosis. The patient remains euglycaemic eight months post-operatively.
ISSN:1479-666X
2405-5840
DOI:10.1016/S1479-666X(08)80097-2