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Insulinoma associated with pituitary adenoma: A potential case of sporadic nem-1? A case study

Abstract:

Insulinomas are neuroendocrine tumors derived from insulin-producing β cells located in pancreatic islets, whose clinical manifestation is mainly characterized by hyperinsulinemia and severe hypoglycemia. We report the case of a 31 years-old female patient, with a history of frequent episodes of hypoglycemia within a period of 6 months, whose clinic was characterized by dizziness, palpitations, sweating, weakness, malaise, irritability, aggression and even tonic-clonic seizures. Incidentally, breast milk secretion was detected in exploration. During follow-up, serum glucose levels were documented between 26 mg/dL and 45 mg/dL during hypoglycemia crisis. Fasting levels of insulin, C-peptide and prolactin were quantified, resulting in 39.8 mIU/mL, 4.7 ng/dL, and 126 ng/dL respectively. Under clinical suspicion of insulinoma abdominal ultrasound and CT scan of abdomen and pelvis with contrast were indicated and the results were inconclusive. Parallel, a pituitary adenoma was found by sellar nuclear magnetic resonance. Given the persistence of symptoms, an endoscopic ultrasound was done, revealing a slightly hypoechoic tumor of 1.9 x 1.3 cm, located in the body of the pancreas. This finding led to fine needle biopsy confirming a well differentiated neuroendocrine tumor. Insulinoma was surgically removed by laparoscopically distal pancreatectomy with splenic preservation. Immunohistochemical pathologic examination revealed the presence of an insulin-producing encapsulated adenoma derived of pancreatic islet cells.