Hyperinsulinaemic hypoglycaemia - a diagnostic challenge. A report of two atypical cases.

  • Renata Baronaite Hansen Department of Medical Endocrinology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
  • Ulla Feldt Rasmussen Department of Medical Endocrinology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
  • Åse Krogh Rasmussen Department of Medical Endocrinology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
  • Carsten Palnaes Hansen Department of Gastrointestinal Surgery & Transplantation, Neuroendocrine Tumour Center of Excellence, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
  • Ulrich Knigge Department of Gastrointestinal Surgery & Transplantation, Neuroendocrine Tumour Center of Excellence, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

Keywords

Hyperinsulinaemic hypoglycaemia, insulinoma, glucagonoma, malignant insulinoma, nesidioblastosis.

Abstract

Objectives: The authors describe 2 atypical cases of patients with hypoglycaemia, suspected for insulinoma.

Methods: The 2 reports are accompanied by a concise review of the literature.

Results: Patient 1 had a distal pancreatectomy performed for suspected insulinoma, and was diagnosed with a glucagonoma and beta-cell hyperplasia (nesidioblastosis). To the authors’s knowledge, co-existing glucagonoma and nesidioblastosis had not been previously reported.
Patient 2 was diagnosed with a benign insulinoma and 5 years later with metastatic disease.

Conclusion: The authors conclude that insulinomas are rare entities which often present a diagnostic and therapeutic challenge. In such cases, patient referral to tertiary multidisciplinary centers is recommended.

References

  • Halfdanarson TR, Rubin J, Farnell MB, Grant CS, et al. Pancreatic endocrine neoplasms: epidemiology and prognosis of pancreatic endocrine tumors. Endocr Relat Cancer. 2008;15:409-27.

  • Falconi M, Bartsch DK, Eriksson B, Kloppel G, et al. ENETS Consensus Guidelines for the management of patients with digestive neuroendocrine neoplasms of the digestive system: well-differentiated pancreatic non-functioning tumors. Neuroendocrinology. 2012;95:120-34.

  • Jensen RT, Cadiot G, Brandi ML, de Herder WW, et al. ENETS Consensus Guidelines for the management of patients with digestive neuroendocrine neoplasms: functional pancreatic endocrine tumor syndromes. Neuroendocrinology. 2012;95:98-119.

  • Metz DC, Jensen RT. Gastrointestinal neuroendocrine tumors: pancreatic endocrine tumors. Gastroenterology. 2008;135:1469-92.

  • Knigge U, Hansen CP. Surgery for GEP-NETs. Best Pract Res Clin Gastroenterol. 2012;26:819-31.
  • Published: 2015-07-17

    Issue: Vol 2 No 4 (2015) (view)

    Section: Articles

    How to cite:
    Baronaite Hansen, R., Feldt Rasmussen, U., Krogh Rasmussen, Åse, Palnaes Hansen, C., & Knigge, U. (2015). Hyperinsulinaemic hypoglycaemia - a diagnostic challenge. A report of two atypical cases. European Journal of Case Reports in Internal Medicine, 2(4). https://doi.org/https://doi.org/10.12890/2015_000245