Endocrine Abstracts

83-year-old lady presented to emergency department with intermittent confusion. Detailed history revealed that she had a background of recent posterior circulation ischemic stroke 3 weeks prior. She was then referred from her rehabilitation center to us for episodic unresponsiveness with associated low capillary glucose, improving with intravenous dextrose. Prior to her stroke, she had episodes of intermittent dizziness, usually mid-morning, which resolved with snacks. Past medical history was unremarkable apart from previously treated meningioma, and recent ischemic stroke. No h/o alcohol consumption. No history similar problems in her family. Capillary glucose monitoring showed intermittent hypoglycemia during her stay, confirmed with venous glucose. She fulfilled Whipple’s triad, warranting further tests. Routine biochemistry, liver and renal function were normal. Sulfonylurea screen was negative. Plasma C-peptide levels were significantly raised, with low paired plasma glucose. CT abdomen showed a cystic lesion in the uncinate process of the pancreas. Octreotide scan confirmed the diagnosis of an insulinoma at the same site. Looking back, it was likely recent stroke was precipitated by a severe hypoglycemia episode, given preceding symptoms. Ideally, surgical resection is the mainstay of treatment. However, given her age, and frailty post-stroke, the multi-disciplinary team meeting, and patient, favored conservative medical management. She was commenced on long-acting somatostatin analogue and provided a continuous glucose monitoring sensor. On review, there were no further hypoglycemia episodes and her glucose levels remained above 4 mmol/l on long-acting somatostatin analogue.