Endocrine Abstracts

We present a case of a 45-year-old female referred from cardiology with a history of blackouts and palpitations. Initial investigations by GP revealed T-wave changes on ECG, prompting further evaluations, including 24-hour Holter ECG and echocardiogram. Despite extensive cardiac investigations, the patient’s symptoms persisted, leading to referral to the endocrine clinic. The patient reported frequent episodes of hypoglycaemias-associated symptoms such as excessive eating, blackouts, and fainting. Endocrine evaluation revealed normal short synecthen Test and following that non-suppressed insulin levels with elevated C-peptide during a 72-hour fasting period. A contrast-enhanced CT scan of the pancreas unveiled an enhancing lesion, raising suspicion for insulinoma. The patient was promptly referred to the Neuroendocrine Multidisciplinary Team (MDT) for comprehensive evaluation. Additional tests, including gut hormone profiling and CA 19-9, along with urine metanephrines returned normal results, ruling out other endocrine causes. While awaiting an endoscopic ultrasound (EUS)-guided biopsy for lesion confirmation, the patient was initiated on Diazoxide to manage hypoglycaemias. The biopsy, following discussion in the MDT, confirmed the presence of a neuroendocrine tumor, specifically an insulinoma. The patient was subsequently scheduled for surgical intervention. This case underscores the importance of considering endocrine causes in patients with persistent symptoms despite thorough cardiac evaluations. The atypical presentation of insulinoma as cardiac symptoms highlights the importance of thorough history taking during initial assessment and consideration of hypoglycaemia as a differential diagnosis in patients with ECG changes presenting with such symptoms. In cases where hypoglycaemia is suspected, assessing insulin and C-peptide levels during fasting is crucial for diagnosis. Our experience emphasizes the value of a multidisciplinary approach, involving neuroendocrine specialists, for accurate diagnosis and timely management of insulinomas.