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.