Insulinoma presenting with postprandial hypoglycemia and a low body mass index:A case report

作     者：Dana Prídavková Matej Samoš Roman Kyčina Katarína Adamicová Michal Kalman Margita Belicová Marián Mokáň 

作者机构：Clinic of Internal Medicine ⅠComenius University in BratislavaJessenius Faculty of Medicine in MartinMartin 03601Slovakia Clinic of Surgery and Transplant CenterComenius University in BratislavaJessenius Faculty of Medicine in MartinMartin 03601Slovakia Department of Pathological AnatomyComenius University in BratislavaJessenius Faculty of Medicine in MartinMartin 03601Slovakia 

出 版 物：《World Journal of Clinical Cases》 (世界临床病例杂志)

年 卷 期：2020年第8卷第18期

页      面：4169-4176页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Brown adipose tissue Glycogen deficit Hypoglycemia Insulinoma Underweight Case report 

摘      要：BACKGROUND Insulinomas are the most common type of functioning endocrine neoplasms of the pancreas presenting hypoglycemic symptoms.Patients characteristically develop symptoms while fasting,but some patients have reported symptoms only in the postprandial state.Repeated and prolonged hypoglycemic episodes can reduce the awareness of adrenergic symptoms,and patients may have amnesia,which delays diagnosis.CASE SUMMARY We describe a case of a 24-year-old underweight patient who showed hypoglycemic symptoms for almost 6 years.Although patients with insulinoma characteristically develop symptoms while fasting,this young man had hypoglycemic symptoms up to one hour postprandially,especially after highsugar meals and after physical activity.The fasting tests and imaging methods performed at local hospitals were evaluated as negative for abnormal results.However,brown adipose tissue exhibited increased metabolic activity,and some muscle groups had histological changes as indicated by positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography.Glycogen deficiency was also histologically confirmed.The patient’s symptoms progressed over the years and occurred more frequently,i.e.,several times a month,and the patient had reduced awareness of adrenergic symptoms.The follow-up fasting test was positive,and the imaging results showed a tumor in the head of the pancreas.The patient underwent laparotomy with enucleation of the insulinoma.CONCLUSION Weight gain and fasting hypoglycemia are not necessarily characteristics of insulinoma.In prolonged cases,adrenergic symptoms can be suppressed.