Endocrine Abstracts

Introduction: Insulinomas are the commonest hormone-secreting tumor of gastrointestinal tract. Presentation is usually insidious with neuroglycopenia and fasting hypoglycemia. Many patients do not report adrenergic symptoms of hypoglycemia and present with neurological or psychiatric manifestations that often lead to misdiagnosis. The symptoms of insulinoma lack specificity, including various seizure disorders, personality change, bizarre behavior, amnesia, convulsions, and incidentally dystonia and polyneuropathy and cause delay in diagnosis. This case highlights the importance of considering hypoglycemia in atypical neurological or psychiatric episodes.

Case Report: A 29 yr man had 1yr history of multiple seizure episodes despite being on regular 3 antiepileptic drugs. Episodes occurred on awakening in early morning. The attacks were episodic stereotyped confusional spells characterized by abnormal posturing, perioral and eyelid twitching and unresponsiveness. Compliance was checked and metabolic causes ruled out. MRI Brain was normal. No interracial epileptic activity observed on video EEG monitoring. He presented with unconsciousness and hypoglycemia (48 mg/dl) which recovered immediately after treatment. It was apparent that his previous seizures tended to occur in early morning or several hours after the meal and post seizure confusion state could be shortened if he ate something. The patient gained 10 kg weight in last 6 months. Endocrine evaluation suggested insulinoma. CT revealed a solitary insulinoma in the head of pancreas. The patient had surgical removal and benign insulinoma was confirmed on histopathology.

Conclusion: 1) Many patients with an insulinoma do not report the adrenergic symptoms of hypoglycemia and present with neurological or psychiatric manifestations that often lead to misdiagnosis. 2) Seizure disorder has been described in few contemporary cases of persistent hypoglycemia later on diagnosed as insulinoma and insulinoma presenting first time with refractory seizures is rare. 3) Benign insulin secreting adenomas are a potentially curable cause of seizures but may be fatal if unrecognized. 4) Our case reiterates the importance of evaluating the metabolic cause of refractory seizure disorders. 5) Early diagnosis and treatment can free many patients from burdensome multiple antiepileptic treatments.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.