Endocrine Abstracts

Introduction: Insulinomas are pancreatic neuroendocrine tumors (PNET), characterized by insulin hypersecretion syndrome with the development of hypoglycemia. The incidence of the tumor is 3-10 cases per million inhabitants. The average age of onset is 40-50 years old, being more frequent in women.

Case Reports: We present a clinical case of a patient with CREST syndrome and difficult-to-control hypoglycemia. Female patient, 81 years old, with a history of CREST syndrome (calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) with multiple complications (esophagitis with scleroderma, vasculitis, nail ulcers) and hypertension. The patient is transferred to the Emergency Department in February 2020 due to loss of consciousness coincident with fasting plasma glucose 27 mg/dl. She had no history of diabetes, previous episodes of hypoglycemia, or apparent intake of hypoglycemic drugs. She was admitted to the Endocrinology Service for study. Refers to asthenia anorexy and weight loss of about 5 kg in the last two months which attributes to dental intervention., although it recognizes significant intake of fast-absorbing sugars. At baselane, insulin 3.2 mcUi/ml, proinsulin 5.8 pmol/l, HbA1c 3.8%, beta hydroxybutyrate <1, C-peptide 1.92 ng/ml, negative oral antidiabetics and anti-insulin antibodies, coinciding with fasting plasma glucose 35 mg/dl. After analytical confirmation of endogenous hyperinsulinism, we started treatment with fluid therapy, requiring a contribution of 1500 ml of 10% dextrose fluid daily to keep fasting plasma glucose in range. Abdominal CT with intravenous iodinated contrast in basal phase evidenced a 12x15 mm hypodense lesion in the tail of the pancreas with enhancement in the portal phase suggestive of insulinoma. Given clinical and radiological suspicion of insulinoma and given the impossibility of suspending intravenous glucose fluid, treatment with diazoxide it was considered. Initially presents good tolerance and evolution, with progressive reduction of the requirements of intravenous glucose. However, after 6 days of treatment, he develops picture of pruritic skin lesions that do not disappear on pressure compatible with erythroderma. Evaluated by allergy service confirming allergy to diazoxide, started treatment with steroids. Consequently, the treatment was discontinued., being the evolution of the lesions favorable. In the absence of a medical therapeutic alternative, finally required surgical treatment. Distal pancreatectomy with a pathological result of a low-grade neuroendocrine tumor compatible with insulinoma. After surgery, he maintains excellent glycemic control, without hypoglycemia. Nonetheless, the patient presented a torpid postoperative period (acute renal failure, cavitary pneumonia with therapeutic bronchoscopy, respiratory failure with invasive mechanical ventilation) and she finally died.