SHM Converge Scientific Abstract ePoster Gallery-The More You 'Noma: Evaluating a Case of Recurrent Hypoglycemia

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This case describes a 65-year-old woman with recurrent episodes of confusion and relief after eating, ultimately found to have severe hypoglycemia. Her history included hypertension, hyperlipidemia, and prior Roux-en-Y gastric bypass. During evaluation, she had glucose readings as low as 34–36 mg/dL. A monitored fast showed that insulin, proinsulin, and C-peptide were not clearly elevated, and sulfonylurea screening, TSH, and cortisol were normal, illustrating that normal insulin levels do not exclude an insulinoma.<br /><br />Abdominal MRI revealed a 15 mm hypervascular mass in the pancreatic tail, suspicious for a pancreatic neuroendocrine tumor, with two smaller possible additional tumors. Because of the imaging findings, she underwent EGD/EUS with biopsy followed by distal pancreatectomy, splenectomy, and cholecystectomy. Pathology confirmed a well-differentiated neuroendocrine tumor with negative margins and no lymph node metastasis. Importantly, the specimen also showed diffuse islet cell hyperplasia resembling nesidioblastosis, with small tumorlets corresponding to the additional radiographic lesions. Pathology suggested she could remain at risk for recurrent hypoglycemia even after apparently complete resection.<br /><br />The discussion highlights that recurrent hypoglycemia should prompt consideration of rare causes such as insulinoma and nesidioblastosis. Insulinomas are uncommon, often solitary pancreatic lesions, and MRI is a useful imaging modality. Treatment is usually surgical resection when feasible. Nesidioblastosis is a distinct entity involving pancreatic ductular/islet cell proliferation; in adults, it is rare and management may include dietary modification, octreotide, or surgery. After surgery, this patient had no recurrent hypoglycemia during 7 months of follow-up.

Asset Subtitle

Abigail Erinc

Meta Tag

Author List Abigail Erinc

Category Clinical Vignettes

Concept Recurrent Hypoglycemia

Concept Insulinoma

Concept Fasting Hypoglycemia

Concept Nesidioblastosis

Concept Pancreatic Neuroendocrine Tumor

Distinguished Non-Finalist

Presenter Organization University of Michigan

Presenting Author Abigail Erinc

Track Adult

Keywords

hypoglycemia

insulinoma

nesidioblastosis

pancreatic neuroendocrine tumor

Roux-en-Y gastric bypass

pancreatic tail mass

hypervascular pancreatic lesion

distal pancreatectomy

EUS biopsy

islet cell hyperplasia

Recurrent Hypoglycemia

Insulinoma

Fasting Hypoglycemia

Nesidioblastosis

Pancreatic Neuroendocrine Tumor