Endocrine Abstracts

Introduction: Insulinoma is a rare small-size pancreatic endocrine tumor with an annual incidence of 0. 4 cases per 100.000 persons. Approximately 10% are multiple tumors, and its diagnosis and detection remain a challenge. Its symptoms are related to neuroglycopenia and increased catecholamine secretion. It may mimic cardiac, psychiatric, or neurological conditions, thus often leading to a delay in diagnosis.

Observation: A 51-year-old female was referred to us for a history of recurrent episodes of severe headaches regardless of food intake, for the last 5 years, without associated signs or symptoms, there were no precipitating factors. She noted that it was relieved by eating. Her appetite has significantly increased over the past years. There was no history of any drug intake. She was obese. On examination, she weighed 80 Kg, and her body mass index was 32, 92 kg/m² The neurological exam was normal and visual disturbances were denied. Endocrine analysis, showed a decrease in serum glucose level 24 mg/dl, an increased level of insulinemia 14.9 µUI/ml (normal range: 2.60-24.9 µIU/l) and c-peptide 2.97 ng/ml (normal range: 1.1-4.4 ng/ml). She had no organ failure or endocrine deficiencies. Magnetic resonance imaging (MRI) of the brain showed no intracranial lesions. Abdominal and Pelvic magnetic resonance imaging (MRI) with contrast showed well-defined two pancreatic hypervascular lesions involving the body and tail of the pancreas measuring 13 mm and 17mm respectively. The diagnosis of multiple insulinomas was made because of hyperinsulinemic hypoglycemia with Whipple’s triad and magnetic resonance imaging.

Discussion : Chronic and repeated hypoglycemia lowers the patient’s glucose threshold triggers the counterregulatory hormones release and adrenergic symptoms can be suppressed, which delays diagnosis. Typically symptoms associated with insulinoma develop while fasting; only 21% of patients develop symptoms in both the fasting and postprandial states.

Conclusion: This case is interesting because it highlights the importance of a history and a complete physical examination to address the underlying causes of headache related to endocrine disorders. A chronic headache may be the symptoms of insulinoma that first bring the patient to the attention of a physician.