Diagnostic Dilemma in a Patient with Recurrent Hypoglycaemia: An Unusual Case
Introduction: Recurrent hypoglycemia is a part of Whipple’s triad and usually points towards insulinoma as a cause. Presence of metastasis is uncommon in Insulinoma, and other causes should be ruled out.
Aim(s): We present here an unusual case of recurrent hypoglycemia and provide a brief literature review
Materials and methods: Case report: A 59-year old lady presented with perioral numbness and recurrent hypoglycaemia episodes. Serum insulin and C-peptide were normal. Magnetic resonance imaging (MRI) showed oligometastatic liver disease- neuroendocrine tumor on fine needle aspiration cytology (FNAC). Endoscopic ultrasound revealed a 2 X 2.2cm tumor in the head of pancreas, which showed carcinomatous differentiation on FNAC. Patient underwent pancreaticoduodenectomy with hepatic metastatectomy and histopathology was a functioning grade 2 pancreatic neuroendocrine tumor (PNET) secreting an insulin-like factor, with Mib 3%. A proinsulinoma was confirmed on immunohistochemistry (IHC). Patient was put on long acting depot octreotide. She had recurrent hypoglycemic symptoms, which were found to be due to sternal and liver lesions. Multiple treatment modalities, like capecitabine + temozolomide (Cap-tem), everolimus, and 177-Lu PRRT, could not completely control the disease. Patient is now awaiting 213-Bismuth PRRT with Cap-tem.
Conference: 15th Annual ENETSConcerence (2018)
Presenting Author: Desai G
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