Hypoglycemic Syndrome without Hyperinsulinemia. A Diagnostic Challenge

Endocrine Pathology
Belén Pérez-PevidaJavier Escalada

Abstract

The most common cause of organic fasting hypoglycemia in adults is the presence of an insulin-producing pancreatic adenoma, but when high insulin levels are not found, the differential diagnosis is challenging. Misdiagnosis can lead to an unnecessary pancreatectomy. Insulin concentrations may be low in some cases despite a clinical history suggestive of insulinoma. In these cases, a proinsulinoma should be suspected, although the rarity of this condition requires an extensive workup before reaching a final diagnosis. We describe an unusual case of a 38-year-old man with a severe hypoglycemic syndrome due to a proinsulin-secreting pancreatic adenoma. Insulin was measured by the specific assay and suppressed under the lower detection limit during fasting hypoglycemia. Serum proinsulin and C-peptide levels were abnormally elevated, and further tests revealed an islet cell tumor. The tumor was surgically removed, relieving the fasting hypoglycemia. Histopathological study showed a conventional well-differentiated neuroendocrine tumor with high immunoreactivity against proinsulin and with lesser intensity against insulin. Interestingly, GS-9A8 antibody clone used for immunostaining proinsulin did not cross-react with human insulin o...Continue Reading

References

Sep 1, 1995·The Journal of Histochemistry and Cytochemistry : Official Journal of the Histochemistry Society·M Bendayan
Oct 29, 2005·Best Practice & Research. Clinical Gastroenterology·Clive S Grant
Mar 27, 2007·Best Practice & Research. Clinical Endocrinology & Metabolism·Wouter W de Herder
Nov 29, 2007·Current Opinion in Oncology·Steven B GoldinMonika M Wahi
Jul 29, 2010·Pancreas·Aaron I VinikUNKNOWN North American Neuroendocrine Tumor Society (NANETS)
Jul 19, 2011·Case Reports in Medicine·Gian Paolo FadiniAngelo Avogaro
Oct 2, 2013·The Journal of Clinical Endocrinology and Metabolism·Jean-Marc GuettierPhillip Gorden

❮ Previous
Next ❯

Citations

May 17, 2017·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Timothy D MurthaRonald R Salem
Oct 12, 2018·Endocrinology, Diabetes & Metabolism Case Reports·Seong Keat CheahSinghan Krishnan
Aug 26, 2016·Journal of Diabetes Science and Technology·Andreas PfütznerGunther Burgard
Nov 27, 2019·Gastrointestinal Tumors·Andrey Germanovich KrigerMarina Yur'evna Yukina

❮ Previous
Next ❯

Related Concepts

Related Feeds

Carcinoma, Islet Cell (Keystone)

Islet Cell Carcinoma or Pancreatic Neuroendocrine Tumours arise in the hormone producing cells of the pancreas. These tumors can be either malignant or benign. Discover the latest research on islet cell carcinoma in this feed.

Carcinoma, Islet Cell

Islet Cell Carcinoma or Pancreatic Neuroendocrine Tumours arises in the hormone producing cells of the pancreas. These tumors can be either malignant or benign. Discover the latest research on Islet Cell Carcinoma here.

Adenoma, Islet Cell

Islet Cell Adenoma arises in the islet cells, which are insulin producing cells of the pancreas. These tumors can be either malignant or benign. Discover the latest research on Islet Cell Adenoma here.

Related Papers

The Journal of Clinical Endocrinology and Metabolism
Chee W Chia, Christopher D Saudek
JOP : Journal of the Pancreas
Rahul Amreesh GuptaSanjay Nagral
Arquivos De Gastroenterologia
Franz Robert Apodaca-TorrezAntônio Figueira
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP
Aisha SheikhNaeemul Haque
© 2022 Meta ULC. All rights reserved