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Hypoglycemia, Something Lost in Translation

Introduction: Insulinoma is a rare neuroendocrine tumor that may occur sporadically or as part of multiple neuroendocrine neoplasia type 1, with an incidence of 4 per million per year. Given the nonspecific symptoms of hypoglycemia, the diagnosis of insulinoma may be delayed by months, years or even...

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Bibliographic Details
Published in:Journal of the Endocrine Society 2021-05, Vol.5 (Supplement_1), p.A998-A998
Main Authors: Al-Naqeeb, Ghadah, Neupane, Rabin, Baral, Neelam, Gao, Faye, Steves, Mark, Wexler, Jason Adam
Format: Article
Language:English
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Summary:Introduction: Insulinoma is a rare neuroendocrine tumor that may occur sporadically or as part of multiple neuroendocrine neoplasia type 1, with an incidence of 4 per million per year. Given the nonspecific symptoms of hypoglycemia, the diagnosis of insulinoma may be delayed by months, years or even decades. Case Presentation: A 50 year-old Hispanic, Spanish speaking male with a history of hypertension presented with progressive epigastric pain, nausea and bilious vomiting for 2 days. Physical exam was notable for abdominal distention and tenderness. Initial labs showed white blood cells of 19.4 k/uL (4-10.8), glucose of 85 mg/dl (65-140). CT abdomen showed findings consistent with moderate grade small bowel obstruction and normal pancreas. The patient was managed conservatively with nasogastric tube placement and nothing per oral (NPO). Within 8 hours started experience sweating, restlessness, fingerstick glucose was 40 mg/dl. Upon questioning, he reported episodes of lightheadedness, sweating and shakiness 8 years prior to this hospitalization, and he recalled being told that he was hypoglycemic during prior hospitalizations at another institution. He stated he was told to drink juice upon experiencing such symptoms and no work up or diagnostic investigation was recommended. We initiated a hypoglycemia investigation when he was NPO, when serum glucose level of 40 mg/dl. Labs showed insulin level 34 uIU/mL (3-19), free insulin 25 uIU/mL (3-19), C-peptide 3.32 ng/mL (0.81-3.85), beta hydroxybutyrate
ISSN:2472-1972
2472-1972
DOI:10.1210/jendso/bvab048.2042