Repeated Episodes of Low Blood Sugar!

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Insulinoma: low blood sugar
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A 35-year-old woman had multiple episodes of hypoglycemia (low blood sugar levels). Later she was diagnosed with insulinoma!

A 35-years old female presented 9 weeks after delivering her first child with complaints of altered consciousness, disorientation, and double vision. Initially, the doctors suspected hypoglycemia, however, the patient’s blood sugar levels were normal. To determine the aetiology, the doctors admitted her to rule out epilepsy.

Magnetic resonance imaging (MRI) of the brain showed no remarkable pathology. Since her investigations did not reveal any significant pathology, the doctors discharged the patient. However, 2–3 days after discharge, fell unconscious. Her blood glucose level was 38 mg/dL. Therefore, the patient received glucose and she stabilised.

The doctors suspected a dissociative disorder and post-partum depression, therefore, they transferred her to the department of psychiatry. During sleep deprivation, she developed another episode of hypoglycemia. She underwent endoscopic ultrasound (EUS) which showed a hyperperfused lesion measuring 1.13 cm in the pancreatic tail.

The findings corelated with the findings evident on the MRI and a Positron emission tomography–computed tomography (PET-CT).

With the investigations, the doctors made a diagnosis of insulinoma.

Insulinoma is a rare tumour of the pancreatic beta islet cells. These are the cells that are responsible for insulin production. An increased number of cells means more insulin, therefore, increased chances of low blood sugar levels. Patients with insulinoma present with a triad of symptoms called the Whipple’s triad, i.e., plasma glucose <50 mg/dL; neuroglycopenic symptoms; and prompt symptom resolution after glucose administration. Approximately, 90% of these tumours are solitary, measure < 2 cm in diameter, and are distributed equally within the head, body, and tail of the pancreas.

It is not unusual for a insulinoma to be misdiagnosed as any psychiatric, cardiac, or neurological disorder.

Mostly, insulinoma requires surgical resection.

The patient underwent laparoscopic enucleation of insulinoma. Thereafter, the surgeons sent the enucleated sample for histopathological analysis which confirmed the diagnosis of an 18 mm neuroendocrine tumour. Moreover, the biopsy showed negative surgical margins and no proof of a lymphatic or vascular invasion.

Post-operatively, the patient continued breastfeeding her baby without any other hypoglycemic episode. The doctors discharged her 8 days later.

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Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

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