UKINETS2018 Poster Presentations (1) (28 abstracts)
Seeking the unseen: a case of occult sporadic insulinoma: localization, surgical strategy: a rare case
Duminda Subasinghe 1 , Sonali Gunathilake 2 , Chandrika Jayakanthi 2 , Eranga Ganewaththa 3 , Noel Somasundaram 2 , Chaminda Garusinghe 2 & Sivasuriya Sivaganesh 1
1Department of Surgery, Faculty of Medicine,University of Colombo, Colombo, Sri Lanka; 2Department of Endocrinology,The National Hospital of Sri Lanka, Colombo, Sri Lanka; 3Department of Radiology, The National Hospital of Sri Lanka, Colombo, Sri Lanka.
Insulinoma is a rare pancreatic neuro endocrine tumour. It is the commonest cause for endogenous hyperinsulinaemic hypoglycemia in a seemingly well individual. Insulinomas are small tumors which may not be detected on conventional imaging modalities. Image negative endogenous hyperinsulinemia poses a diagnostic challenge to the clinicians. Interventional radiological techniques with higher sensitivity can be used in such situations for correct localization of the small s for better accuracy and for planning of successful surgical resection. A 39-year-old male presented with established Whipple’s triad for past 10 months. Clinical evaluation did not reveal possible underlying critical illness, organ failure, autoimmunity, hormone deficiency or surreptitious/malicious hypoglycemic drug use. Biochemical testing including C-peptide level and serum insulin level during hypoglycemia on supervised 72-hour fast test concluded endogenous hyperinsulinaemia as the underlying etiology. Localization testing with MRI and CT abdomen were unable to localize a tumor. Selective arterial calcium stimulation test localized a lesion in distal pancreas which was confirmed by intraoperative ultrasonography. Insulinoma was proven on histological examination following complete enucleation, supported by immunohistochemistry profile with WHO grade 1 tumor. Patient recovered without complications and at 1 year follow up, he was asymptomatic.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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