Metastatic Insulinoma Presenting With Postprandial Hypoglycemia
Open accessAbstract
Background/Objective: Patients with an insulinoma, a type of pancreatic neuroendocrine tumor, typically present with fasting hypoglycemia but can rarely present exclusively with postprandial hypoglycemia. Case Report: A 69-year-old man presented with episodes of postprandial blurry vision, sweating, and confusion for the last 2 years that were becoming more frequent over the last several weeks. Home blood glucose measurements revealed postprandial hypoglycemia (glucose level, 45-70 mg/dL), and symptoms were consistent with the Whipple triad. Continuous glucose monitoring revealed only postprandial hypoglycemia within 2 hours following meals. An outpatient fast was conducted with detectable insulin (6 μIU/mL) and C-peptide (2.0 ng/mL) levels with an elevated proinsulin (20.8 pmol/L) level when the serum blood glucose level dropped to 47 mg/dL (21 hours after the initiation of the fast). A computed tomography scan of the abdomen and pelvis showed a 1.6-cm hyperenhancing lesion in the distal body of the pancreas. He underwent endoscopic ultrasonography with fine-needle aspiration. Pathology revealed a low-grade, well-differentiated, neuroendocrine tumor with lymphovascular invasion and regional lymph node metastases, confirming the diagnosis of a pancreatic neuroendocrine tumor. Discussion: Exclusive postprandial hypoglycemia is estimated to occur in 6% of the insulinomas. Patients with postprandial hypoglycemia may be initially managed as those with reactive hypoglycemia; however, this case highlights the importance of evaluating for an insulinoma in a patient who has failed treatment for reactive hypoglycemia. This case also demonstrates the importance of including proinsulin levels in that evaluation. Conclusion: Pancreatic neuroendocrine tumor should be considered in postprandial hypoglycemia, even in the absence of fasting hypoglycemia. Measuring proinsulin levels is essential in the diagnostic workup of insulinoma causing hypoglycemia.
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Exercise-induced or postprandial hyperinsulinemic hypoglycemia is not a defining feature of NIPHS, since some insulinoma patients also suffer from these symptoms.
“Above all, exercise-induced or postprandial hyperinsulinemic hypoglycemia is not a defining feature of NIPHS, since some insulinoma patients also suffer from these symptoms”
From An Uncommon Cause of Recurrent Presyncope, Dizziness, and Tachycardia: A Case Report of Diffuse, Adult-Onset Nesidioblastosis/Non-Insulinoma Pancreatogenous Hypoglycemia Syndrome (NIPHS) (2023) · cites this paper as [55]
The Discussion (page unavailable) reports that insulinoma can present with postprandial hypoglycemia, supporting the point that this symptom is not exclusive to NIPHS. It does not address exercise-induced hypoglycemia or directly discuss which features define NIPHS. (LLM, conf=0.85)
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Cites
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“postprandially, and (2) this was a proinsulin-producing tu-”
BackgroundMANAGEMENT OF ENDOCRINE DISEASE: Pathogenesis and management of hypoglycemia
Kittah, N. E., & Vella, A. (2017) · European Journal of Endocrinology · doi:10.1530/eje-16-1062 · Cited by 107 · see citing works
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Dieterle, M. P., Husari, A., Prozmann, S. N., Wiethoff, H., Stenzinger, A., Röhrich, M., Pfeiffer, U., Kießling, W. R., Engel, H., Sourij, H., et al. (2023) · Biomedicines · doi:10.3390/biomedicines11061741 · Cited by 5 · see citing works
- Authors
- Maher, M. D., Desai, D. N., & Bajaj, M.
- Affiliations
- Baylor College of Medicine (US)
- Corresponding author
- Maher, Monique Debrah
- Venue
- AACE Clinical Case Reports
- Publisher
- Elsevier BV
- Published
- 2022-07
- Volume
- 8
- Issue
- 4
- Pages
- 154-157
- ISSN
- 2376-0605 (ISSN-L)
- PMC
- PMC9363506
- OpenAlex
- W4286786878
- Cited by
- 5
- References
- 3
- Citations by year
- 2024: 1 · 2023: 3 · 2022: 1
- FWCI
- 0.90
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- AACE Clinical Case Reports (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Digital Commons-TMC (Texas Medical Center) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Neuroendocrine Tumor Research Advances
- Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- insulinoma, postprandial hypoglycemia, pancreatic neuroendocrine tumors, proinsulin, reactive hypoglycemia, lymph node metastasis, Whipple triad, continuous glucose monitoring, fine-needle aspiration, differential diagnosis of hypoglycemia
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