Endocrine Abstracts

A 76-year-old female patient has been admitted to various hospitals with complaints of low blood sugar especially in the morning, sweating, fainting, loss of consciousness, have been suspected of insulinoma with the results of the latest examinations made in 2012, but no focus has been detected. With the same complaints, the patient who applied to our out-patient clinic in December 2017 was subjected to an extended hunger test and invested for further research. Previously, the patient who has HT and COPD diagnoses had a BMI of 39.5 kg/m² and no significant physical examination. On the 3rd hour of the prolonged fasting test started at 0800 h in the morning, the blood sugar was 30 mg/dl while the C-peptide was 11.14 ng/ml and insulin was 58.83 μU/ml. Six millimeter uniformly limited lesion was detected at the head of the pancreas in the withdrawn MRI. The patient was diagnosed insulinoma and EUS was planned, whereas due to technical problems it could not been performed. Triphasic CT was performed instead to clarify the location of the mass and surgical planning. Diazoxide therapy started at the dose of 3×100 mg in the patient who was followed up with Dextroz infusion during this period. After 2 days, the patient’s creatine level rose from 1.33 to 2.45, with hypotension, hyponatremia, pretibial +++/+++ edema, and shortness of breath. The patient was evaluated with nephrology and the drug was discontinued due to the development of acute renal insufficiency secondary to diazoxide. The patient was hemodialized for 2 occasional days. Within 3 days, the patient’s blood pressure and serum sodium level returned to normal levels. The patient who was followed up with Dextroz infusion was considered to be at high risk for surgery although the biochemical parameters returned to normal. The DOTA-PET was scheduled and until that time 2×1 dose of octreotide 0.1 mg SC short effective treatment was started. The patient recovered from hypoglycemia with this treatment, but sudden increase in creatinine level and atrial fibrillation was observed. We decreased dose of Octreotide to 1×0.1 mg in the patient who started cordarone infusion for arrhythmia. The final creatinine level of the patient was 1.5 and blood sugars were maintained in the normal ranges. The patient was discharged with current treatment to be implemented Radiofrequency occlusion therapy for pancreatic mass. Diazoxide is usually well tolerated whereas could be dangerous simetimes.