Endocrine Abstracts

Background: Insulinoma in a pre existing patient of type diabetes is extremely rare presentation.

Methods: We are presenting a a rare case of insulinoma in a pre existing case of type 2 diabetes. A 73 years old patient with type 2 diabetes for 35 years presented to endocrine clinic with hypoglycaemic symptoms ultimatley diagnosed with insulinoma and patient developed renal failure with diazoxide treatment.

Result: A 73 years old chinese lady who presented to endocrine clinic with symptoms of hypoglycaemia for 12 months. She was a type diabetic patient for 35 years and using metformin.

Her metformin was stopped by her doctor but still she was getting hypoglycaemic symtoms.She use to take four bottles of lucozade a day to treat her symptoms.

She was started on 72 hours fasting test and she developed hypoglycaemic episode with 6 hours of starting fast. Her biochemical profile was consistent with insulinoma.An ultrasound abdomen showed possible mass in distal pancreas which was confirmed by CT abdomen. She was started on diazoxide and in few days she developed vasodilation and diazoxide toxicity.She went to renal failure secondary to diazoxide and transferred to ITU for haemofilteration. Her diazoxide was stopped and she was started on octreotide.

She had distal pancreatectomy and histology was consistent with well differentiated neuroendocrine tumour, grade 1 with ki67 index 4%.

Conclusion: In case of dramatic improvement in diabetes control and hypoglycaemias in a long standing type 2 diabeteic patient, one should always consider the possibility of insulinoma.