ECE2024 Eposter Presentations Pituitary and Neuroendocrinology (214 abstracts)
Insulinoma: diagnostic difficulties of a rare tumor
Marwa El Arem 1 , Bilel Ben Amor 2 , Ekram Hajji 1 , sana abid 1 , Ines Bayar 1 , Héla Marmouch 1 , Hanene Sayadi 1 & Inès Khochteli 1
1Hospital Fatouma Bourguiba, endocrinology; 2Hospital Fatouma Bourguiba
Introduction: Insulinoma is a rare neuroendocrine tumor. Its diagnosis is clinico-biological. Preoperative topographical diagnosis is necessary to guide the therapeutic procedure.
Observation: We report the case of a 37-year-old patient, without notable pathological history, who was admitted for exploration of severe hypoglycemia, not felt, evolving for 2 years and complicated by convulsive attacks. The initial etiological investigation revealed corticotropic insufficiency and thyrotropic insufficiency. Despite substitution with hydrocortisone and L-thyroxine, hypoglycemia persisted. The dosage of insulinemia and C-peptide, carried out at the time of hypoglycemia, were inappropriate, thus confirming the presence of associated endogenous hyperinsulinism. The concomitant dosage of sulphonylureas was negative. Pancreatic MRI and CT angiography were normal. Likewise, the octreoscanner did not show any pathological uptake in the pancreas. Endoscopy ultrasound showed a small cystic lesion measuring 8x9 mm at the level of the pancreatic uncus. The cytopathological examination after cytopuncture showed an immunocytochemical appearance compatible with a neuroendocrine tumor. A second CT angiography, guided by the endoscopic ultrasound results, confirmed the presence of a cystic tumor at the level of the uncus. The patient underwent enucleation with disappearance of the hypoglycemia.
Conclusion: The cystic form of insulinoma is exceptional. In our case, only endoscopic ultrasound allowed the localization of this particular form.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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