Lesson of the month 2: An unusual presentation of hyperinsulinaemic hypoglycaemia with possible underlying diagnosis of glucose-sensitive insulinoma or islet cell hyperplasia
Open accessAbstract
Postprandial hypoglycaemia can occur in islet cell hyperplasia and in reactive hypoglycaemia. Less commonly, it can occur with insulinoma. A case is described where the differential diagnosis was glucose-sensitive insulinoma or islet cell hyperplasia. Typical provocation was prolonged exertion or fasting followed by ingestion of sugary snacks resulting in hypoglycaemic seizures and collapse. Biochemistry and computerised tomography imaging were consistent with an insulinoma in the pancreatic tail, but this was not confirmed on endoscopic ultrasound. Selective intra-arterial calcium stimulation with hepatic venous sampling results suggested a diagnosis of islet cell hyperplasia. Ten years later, repeat imaging was consistent with a neuroendocrine tumour. Surgical resection has resulted in remission of symptoms. The patient will be monitored long term to ensure no recurrence.
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A positive fasting test neither confirms insulinoma nor excludes NIPHS.
“As can be seen from our case and other reports in the literature, a positive fasting test neither confirms insulinoma nor excludes NIPHS [53,54].”
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Cites
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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/biomedicines11061732 · Cited by 19 · see citing works
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
“As can be seen from our case and other reports in the literature, a positive fasting test neither confirms insulinoma nor excludes NIPHS [53,54].”
ResultRecurrent diaphoresis, acute confusional state, and pleural mesothelioma
Domínguez, R. O., Cárdenas, E. M. S., Marulanda, Y. H. S., & Bartolomé, E. L. (2017) · Neurología (English Edition) · doi:10.1016/j.nrleng.2015.12.009
Diaforesis recurrente, estado confusional agudo y mesotelioma pleural
Domínguez, R. O., Cárdenas, E. M. S., Marulanda, Y. H. S., & Bartolomé, E. L. (2016) · Neurología · doi:10.1016/j.nrl.2015.12.005
- Authors
- Maguire, D.
- Affiliations
- Harrogate District Hospital (GB)
- Corresponding author
- Maguire, Deirdre
- ORCID
- Maguire, Deirdre
- Venue
- Clinical Medicine
- Publisher
- Elsevier BV
- Published
- 2015-10
- Volume
- 15
- Issue
- 5
- Pages
- 495-496
- ISSN
- 1470-2118 (ISSN-L)
- PMC
- PMC4953241
- OpenAlex
- W2174858022
- Cited by
- 4
- References
- 11
- Citations by year
- 2023: 2 · 2017: 1 · 2016: 1
- FWCI
- 0.52
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Clinical Medicine (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- 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
- hyperinsulinemic hypoglycemia, islet hyperplasia, postprandial hypoglycemia, reactive hypoglycaemia, hepatic venous sampling, neuroendocrine tumors, pancreatic tail, differential diagnosis, surgical resection
- MeSH terms
- Adult, Diagnosis, Differential, Humans, Hyperinsulinism, Hyperplasia, Hypoglycemia, Insulinoma, Islets of Langerhans, Male, Pancreatic Neoplasms, Congenital Hyperinsulinism
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