Endocrine Abstracts

Male, 29 years old. Go to consultations in our center for a second opinion for assessment of hypoglycemia. The patient has reported, for 3 years, symptoms consisting of episodes of dizziness and headache predominantly during the day, which subside after eating food, and which increase in frequency in relation to exercise. He provides capillary glycaemia objectified in family glucometer between 40-70 mg/dl coinciding with the episodes. The patient was initially treated at another center, which after a study (04/2012: glucose 62 mg/dl, insulin 5.89 mcIU/ml, C-peptide 4.5 ng/ml, TSH 1.93 mcIU/ml, HGH 0.09 ng/ml, IGF-1 264 ng/ml, basal cortisol 16.09 mcg/dl) is classified as reactive hypoglycemia and hygienic-dietary measures are prescribed by means of a divided diet and avoiding the intake of rapidly absorbed carbohydrates. We admitted the patient to perform a fasting test (07/2012), which was positive at 30 hours (glycemia 36 mg/dl, insulin 4.46 mcIU/ml, C-peptide 1.51 ng/ml) compatible with hyperinsulinemic hypoglycemia. Treatment with diazoxide 100 mg 1-0-1 was prescribed at discharge. A localization study consisting of an abdominal CT scan was performed, which revealed a doubtful 1.4 cm lesion in the body of the pancreas. It is completed with pancreatic MRI that does not describe the lesion mentioned in the CT. To determine the etiology, the patient was admitted on 09/2012 to perform an arterial calcium stimulation test by selective pancreatic catheterization, which was negative for insulinoma, since only a 21% increase in blood insulin was observed in the splenic artery and no it is observed in the rest (hepatic or superior mesenteric). It is decided in principle management with medical treatment and follow-up with imaging tests. It is performed during the same CT scan of the pancreas every 2 years and 2 echoendoscopies. In the last ultrasound endoscopy performed (10/2017), pancreatic lesions compatible with insulinoma were still not observed. There is talk of diffuse ultrasound changes in pancreatic tissue, to rule out nesidioblastosis. The patient remains relatively controlled with medical treatment and pancreatic surgery is not proposed.