Endocrine Abstracts

Introduction: Co-morbidity of DM t 2 and insulinoma is extremely rare. There are only some case reports of diagnosing insulinoma but they concern patients already diagnosed with DM t. 2. We present patient diagnosed at the same time with DM t. 2 and insulinoma.

Case report: A 69-year-old female patient was admitted to hospital because of high blood pressure. Since 2 years she reported attacks of weakness, tachycardia and sweating within the day, usually several hours after food intake or directly after physical effort or rarely while fasting. The food intake resolved the symptoms. Physical examination revealed blood pressure 200/100 mmHg, BMI 26 kg/m², abdominal obesity, waist circumflex 89 cm. By prolonged 5-hours OGTT diabetes with reactive hypoglycemia at hour 5 of test was diagnosed. Abdominal US revealed hepar steatosis. Antibodies: anti-GAD, ICA, IAA were negative. During hospitalization fasting glycaemia levels were within range of 3.22–6.33 mmol/l and postprandial levels were: 3.61–8.94 mmol/l. Hypothyroidism, adrenal insufficiency, kidney and hepar failure were excluded. Screening cancer exams were negative. We performed fasting test. After 14 h symptomatic hypoglycaemia: 2.44 mmol/l was observed with inadequately high levels of insulin and C-peptide. Endogenic hyperinsulinaemia was diagnosed. CT scans revealed pancreatic tumor diameter 17 mm. The patient underwent surgical treatment. Histopathological examination confirmed well differentiated endocrine tumor. 3 months after operation she was treated with metformine and remained euglicaemic. C-peptide level was normalized.

Conclusion: 1. Diagnosis of DM t 2 should not be followed by abandoning diagnosis of fasting hypoglycaemia when there are morning or frequent postprandial hypoglycemia episodes within the day.

2. Hypoglicaemia must not be always typical sign of the early stage o the diabetes mellitus. Other causes should be considered even insulinoma.