Endocrine Abstracts

23-year old man was admitted to Endocrinology Department because of hypogonadism and pituitary tumor seen at CT. Diagnosis of prolactinoma was established based on high serum PRL level- 800 ng/ml and therapy with bromocriptine was instituted. On the next year a temporary loss of consciousness related to physical exertion occured. The neurological reasons were excluded and laboratory tests showed hypercalcemia, hypophosphatemia and elevated serum PTH levels. Prolactinoma and hyperparathyroidism made the diagnosis of MEN 1 so the insulinoma as the cause of consciousness loss was taken into account. During fasting test hypoglicemia 36 mg/dl and hyperinsulinemia 40 μU/ml was documented. Therapy with diazoxide was instituted and patient was transferred to Surgical Department. Insulinoma was not found no preoperatively nor during surgical exploration. Distal subtotal pancreatectomy was carried out but hyperinsulinemia persisted. Micoscopical analysis showed multiple pancreatic adenomas up to 0.5 cm in diameter.

On the next year subtotal parathyreoidectomy was established. 5 years later, abdominal pain and nusea occured. During gastro-duodenal endoscopy gastric hyperemia and wide duodenal ulcer was seen. Elevated levels of BAO- 15 mEq/h, MAO- 38 mEq/h and gastrin- 530 pg/ml were relevant to gastrinoma. The patient did not accepted further diagnostic procedures nor possible surgical treatment.

This case shows some different features of insulinoma associated with MEN 1 compared to sporadic insulinoma: 1/ insulinoma in MEN 1 is usually multifocal and surgery might be unsuccessful, 2/ GEP in MEN 1 can be multihormonal so strict clinical and biochemical surveillance is needed.