Details

Autor(en) / Beteiligte

• Mohamed Shah, Fatimah Zaherah
• Mohamad, Aimi Fadilah
• Zainordin, Nur Aisyah
• Eddy Warman, Nur' Aini
• Wan Muhamad Hatta, Sharifah Faradila
• Abdul Ghani, Rohana

Titel

A case report on a protracted course of a hidden insulinoma

Ist Teil von

• Annals of medicine and surgery (2012), 2021, Vol.64, p.102240-102240

Erscheinungsjahr

2021

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• INTRODUCTIONInsulinoma is a functioning pancreatic neuroendocrine tumor primarily leading due to hypoglycemia due to hypersecretion of insulin. This case illustrates the real challenges faced in the detection of an occult insulinoma, which resulted in a protracted course of the disease. CASE PRESENTATIONA 33-year-old female presented with recurrent hypoglycemia. Endogenous hyperinsulinemia was confirmed by a prolonged fast, however serial imaging was negative. Incidental finding of an ovarian mass gave rise to the suspicion of an insulin-producing ovarian tumor. Subsequent multimodality pancreatic imaging remained negative, requiring more invasive investigations. The tumor was localized by specialized arteriography using calcium stimulation to support the diagnosis of an insulinoma. However, repeated negative imaging led to further delays in definitive management, with worsening hypoglycemia. The surgery was finally performed three years after the initial presentation with successful removal of the tumor using intra-operative ultrasound. CLINICAL DISCUSSIONIt is important to emphasize that preoperative radiological imaging is useful to localize pancreatic lesions. However, most insulinomas could only be detected intraoperatively. The absence of suggestive radiological evidence should not deter surgeons from proceeding with definitive surgical intervention. CONCLUSIONThe case highlights the importance of a multidisciplinary approach in the management of a complicated case.