SHM Converge Scientific Abstract ePoster Gallery-Refractory Hypoglycemia, a Case of an Insulinoma

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This case describes a 63-year-old woman with heart failure with reduced ejection fraction and pre-diabetes who was admitted for lower extremity weakness, edema, hepatomegaly, elevated BNP, and severe liver injury. During hospitalization, she developed recurrent symptomatic hypoglycemia with weakness and tremors, including a documented venous glucose of 40 mg/dL that improved with dextrose.<br /><br />Because the hypoglycemia was spontaneous and persistent despite nutritional support and treatment of her heart failure and liver abnormalities, further evaluation was performed. Labs showed elevated C-peptide, inappropriately normal insulin, elevated proinsulin, low insulin-like growth factor-2, negative insulin antibody testing, and an A1c of 5.7%. These findings supported endogenous hyperinsulinemic hypoglycemia and raised suspicion for insulinoma.<br /><br />MRI of the abdomen identified a 1.1 cm lesion in the proximal jejunum near the ligament of Treitz, concerning for an insulin-secreting neuroendocrine tumor or possibly a gastrointestinal stromal tumor. Hypoglycemia improved with octreotide, dextrose gel, and nutritional supplementation with Glucerna. She was discharged with normoglycemia and close endocrinology follow-up, along with a planned PET scan to evaluate for metastatic disease.<br /><br />The case highlights Whipple’s triad and emphasizes that insulinoma, although rare, should be considered in cases of recurrent or refractory hypoglycemia after more common causes are excluded. Biochemical testing and imaging are essential for diagnosis, and treatment may include surgery or medication.

Asset Subtitle

Shama Pandiri

Meta Tag

Author List Shama Pandiri, Violetta Laskova

Category Clinical Vignettes

Concept Insulinoma

Concept Hypoglycemia

Concept Whipples triad

Concept Biochemical Testing

Concept Hyperinsulinemia

Distinguished Non-Finalist

Presenter Organization Mount Sinai Beth Israel

Presenting Author Shama Pandiri

Track Adult

Keywords

hypoglycemia

insulinoma

Whipple triad

hyperinsulinemic hypoglycemia

C-peptide

proinsulin

octreotide

neuroendocrine tumor

jejunal lesion

endogenous insulin

Insulinoma

Hypoglycemia

Whipples triad

Biochemical Testing

Hyperinsulinemia