Endocrine Abstracts

47 M Presented with increasingly frequent unresponsiveness and hypoglycaemia. Systemic review revealed a recent pattern of similar events, associated profuse sweating and uncharacteristic aggression. The patient had poor memory of the events but reported his symptoms improved by eating and he had gained weight. He also reported eating overnight. Past medical history included a Vasectomy and Haemorrhoids A 72 hour fast was terminated after symptomatic hypoglycaemia at 16 hours of 2.2 mmol/l on capillary blood glucose. Lab results at time as table. Hypoglycaemia was managed with Diazoxide 150 mg PO TDS and the patient was taught self-monitoring of blood glucose and administration of glucagon to allow further investigation as outpatient. Initial CT imaging found no evidence of a pancreatic malignancy or mass. Neuroendocrine MDT review recommended Octreotide scan and arterial phase CT. These were also negative. Endoscopic ultrasound was arranged followed by MRI pancreas which confirmed the lesion seen on ultrasound as a 1.9 cm exophytic mass arising from the posterior aspect of the pancreas adjacent to the splenic artery.Curative surgical management was achieved with a distal pancreatectomy for insulinoma with a histologically well differentiated insulinoma grade 2 R0, 0/3 lymph nodes (pT2 pN0). Post operative course was complicated by duodenal obstruction requiring total parenteral nutrition. Post insulinoma symptomatic sensory and motor neuropathy with chronic fatigue are an ongoing problem. MEN1 testing negative.