Endocrine Abstracts

Introduction

Insulinoma is a rare neuroendocrine tumor with an incidence of 1 to 4 per million person-years. It is the most frequent endocrine tumor of the pancreas and is revealed by a spontaneous hypoglycemia in the absence of insulin or any antidiabetic medication.Only few cases of confirmed insulinoma with pregnancy have been described in the literature. We describe a case of insulinoma discovered early in pregnancy.

Case report

A 24-year-old woman was admitted in our department at 12 weeks of gestation for morning asthenia and loss of conscience, with glycemia inferior to 0.5 g/l. Endogenous hyperinsulinic hypoglycemia was confirmed with a spontaneous hypoglycemia and laboratory blood glucose at 0.41 g/l, a concomitant insulinemia at 6.4 µUI/ml (≥ 3), C-peptide levels at 2.01 ng/ml (≥ 0.6) and absence of sulfonylurea. Localization was assessed by a pancreatic MRI concluding to a 10 mm tumor in the head of the pancreas, with low-signal intensity on T1-weighted images and high-signal intensity on T2-weighted images. A complementary investigation by an endoscopic ultrasound identified 11 * 13 * 8 mm tumor in the head of the pancreas. The patient was operated on at 17 weeks of gestation. The tumor was removed by enucleation during an open surgery. Histologic and immunohistochemical reports concluded to a 15 mm well differenciated neuroendocrine tumor with no angioinvasion. Immediate post-operative follow up was marked by a pancreatic fistula persistent during 5 weeks, treated by drainage. In long-term follow-up, she no longer had hypoglycemia and gave birth at 40 weeks of gestation to a healthy girl weighting 4 kg.

Conclusion

This case highlights a rare clinical presentation of an insulinoma. The confirmation of the diagnosis is through the same biologic investigations than the non-pregnant population. The delay between diagnosis and treatment should be short in order to prevent foetal hypoglycemia.