Endocrine Abstracts

Introduction: The insulinoma is a rare neuroendocrine tumor derived from the beta islet cell of the pancreas. It is usually sporadic and benign in 90% of the cases. It occurs more often in women in their fifties.

Observation: We report the case of 76-year-old women with a medical history of hypertension and dyslipidemia, who was transferred to our department from the emergency unit after a diagnosis of severe episode of hypoglycemia (glucose level at 0.2 g/l) with neurologic manifestations resistant to intra venous glucose supplementation. Indeed, these episodes began in the previous six months with symptoms worsening over time. During her hospitalization, the patient presented a spontaneous hypoglycemia with a glucose level at 0.43 g/l, the insulin level was high at 21.6 μUI/ml > 3 μUI/ml and the peptide C level was at 4.10 ng/ml > 0.6 ng/ml in favor of an endogenous hyperinsulinism. The dosage of hypoglycemic sulfonamides was negative. An abdominal MRI was performed showing a 25 mm exophytic and hyper vascularized mass of the pancreas corresponding to an insulinoma. The patient was referred to surgery which was performed with no complications and the histopathological examination of the removed tissue confirmed the diagnosis of a G2 neuroendocrine tumor.

Discussion: Insulinoma is the most frequent neuroendocrine pancreatic tumor. Surgery represents the first line treatment. Others options such us diazoxide and octreotide can be discussed especially if the malignancy is suspected.