SHM Converge Scientific Abstract ePoster Gallery-I've Got Sugars in Low Places, Where Insulinomas Affect Homeostasis

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This case describes an 80-year-old woman with dementia who had 4 months of intermittent confusion, weakness, and recurrent hypoglycemia that improved after eating. She was previously thought to have hypoglycemia from poor intake, but prior testing showed elevated insulin and C-peptide during low glucose, raising suspicion for insulinoma.<br /><br />On admission, her blood glucose was 44 mg/dL, and she improved with intravenous dextrose. When dextrose was stopped, she became hypoglycemic and confused again. During a hypoglycemic episode, labs showed blood glucose 38 mg/dL with elevated C-peptide (965 pmol/L) and insulin (29 mU/L), consistent with endogenous hyperinsulinemic hypoglycemia. Abdominal CT followed by PET CT revealed a 1.7 cm hypermetabolic mass in the uncinate process of the pancreas, confirming insulinoma.<br /><br />The report emphasizes that insulinomas are rare pancreatic tumors, occurring in about 1–2 people per million and accounting for 1–2% of pancreatic neoplasms. Diagnosis relies on Whipple’s triad: low plasma glucose, symptoms of hypoglycemia, and symptom resolution with glucose administration. Elevated insulin and C-peptide during hypoglycemia further support the diagnosis.<br /><br />Surgery is the gold standard treatment, with imaging used to localize and size the tumor. If surgery is not pursued, medical management can be used, including diazoxide or octreotide. In this case, the patient was started on diazoxide and maintained normal blood glucose without intravenous dextrose.<br /><br />The main takeaway is to keep a high suspicion for insulinoma in patients with unexplained recurrent hypoglycemia, especially when symptoms improve with eating and labs show inappropriate insulin secretion.

Asset Subtitle

Amy Tierney

Meta Tag

Author List Amy Tierney, Elizabeth Cole, Evan Raff, Mukhtar Adem

Category Clinical Vignettes

Concept Whipples triad

Concept Insulinoma

Concept Hypoglycemia

Concept Surgical Resection

Concept Insulin

Distinguished Non-Finalist

Presenter Organization University of North Carolina School of Medicine

Presenting Author Amy Tierney

Track Adult

Keywords

insulinoma

hypoglycemia

endogenous hyperinsulinemia

C-peptide

elevated insulin

pancreatic tumor

Whipple triad

dementia

diazoxide

PET CT

Whipples triad

Insulinoma

Hypoglycemia

Surgical Resection

Insulin