PMID- 36937638
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230321
IS  - 2050-0904 (Print)
IS  - 2050-0904 (Electronic)
IS  - 2050-0904 (Linking)
VI  - 11
IP  - 3
DP  - 2023 Mar
TI  - A case report of insulinoma presenting with seizures and localized on endoscopic 
      ultrasound.
PG  - e6967
LID - 10.1002/ccr3.6967 [doi]
LID - e6967
AB  - Insulinomas are rare functioning neuroendocrine (NEN) tumors. Up to 10% of 
      insulinomas are associated with multiple endocrine neoplasia 1 (MEN1). Most of 
      the tumors present with symptomatic hypoglycemia. Several non-invasive and 
      invasive techniques are used to localize the lesion. We present a case of 
      insulinoma presenting with seizure episodes with negative results on non-invasive 
      imaging diagnosed and localized with endoscopic ultrasound. A 36-year-old male 
      was brought by ambulance to the emergency department with an episode of 
      generalized tonic-clonic seizures. He had been previously healthy and did not 
      have family history of neuro-endocrine tumors. At the time of the attack, the 
      patient's blood glucose checked via point-of-care testing was 28.8 (70-99 mg/dL). 
      He was given IV dextrose. Physical examination after the patient regained 
      consciousness was completely unremarkable. Hypoglycemia workup revealed a normal 
      morning cortisol level of 281 (138-689 nmol/L). Insulin level was 62.4 mcunit/ml 
      (2.36-24.9), and c-peptide was 8.13 (1.1-4.4 ng/mL) consistent with 
      hyperinsulinemia. Magnetic resonance cholangiopancreatography (MRCP), 
      fluorine-18-l-dihydroxyphenylalanine whole-body positron emission tomography scan 
      (NM 18F-DOPA whole-body PET scan), and gallium Ga 68 dodecanetetraacetic acid 
      (Ga-68 DOTATATE) scan were normal and did not reveal any pancreatic lesion 
      consistent with insulinoma. Due to high suspicion of insulinoma and negative 
      non-invasive imaging, an endoscopic ultrasound (EUS) was performed, which showed 
      a hypoechoic homogenous mass lesion sized 13 x 9 mm in the proximal body/neck of 
      the pancreas. A fine needle biopsy (FNA) via EUS was performed. Histopathology 
      showed a well-differentiated neuroendocrine tumor, consistent with Grade 1 
      insulinoma (T1N0M0). The patient underwent a distal pancreatectomy and 
      splenectomy. In cases of high clinical and biochemical suspicion of insulinoma 
      but negative non-invasive imaging, invasive modalities should be used to localize 
      the culprit lesion.
CI  - (c) 2023 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
FAU - Umer, Waseem
AU  - Umer W
AUID- ORCID: 0000-0003-0476-2224
AD  - Internal Medicine Department Hamad Medical Corporation Doha Qatar.
FAU - Mohammed, Ahmed Salah
AU  - Mohammed AS
AD  - Internal Medicine Department Hamad Medical Corporation Doha Qatar.
FAU - Khan, Adeel Ahmad
AU  - Khan AA
AD  - Internal Medicine Department Hamad Medical Corporation Doha Qatar.
AD  - Department of Endocrinology Hamad Medical Corporation Doha Qatar.
FAU - Saddique, Muhammad Umar
AU  - Saddique MU
AD  - Internal Medicine Department Hamad Medical Corporation Doha Qatar.
AD  - Department of Gastroenterology Hamad Medical Corporation Doha Qatar.
FAU - Zahid, Muhammad
AU  - Zahid M
AD  - Internal Medicine Department Hamad Medical Corporation Doha Qatar.
AD  - Assistant Professor in Clinical Medicine Weill Cornell Medical College Doha 
      Qatar.
AD  - Assistant Professor in Clinical Medicine School of Medicine, Qatar University 
      Doha Qatar.
LA  - eng
PT  - Case Reports
DEP - 20230314
PL  - England
TA  - Clin Case Rep
JT  - Clinical case reports
JID - 101620385
PMC - PMC10014521
OTO - NOTNLM
OT  - PET scan
OT  - endoscopic ultrasound
OT  - hypoglycemia
OT  - insulinoma
OT  - neuroendocrine tumors
COIS- All authors have no conflict of interest.
EDAT- 2023/03/21 06:00
MHDA- 2023/03/21 06:01
PMCR- 2023/03/14
CRDT- 2023/03/20 04:07
PHST- 2022/08/16 00:00 [received]
PHST- 2023/01/31 00:00 [revised]
PHST- 2023/02/02 00:00 [accepted]
PHST- 2023/03/20 04:07 [entrez]
PHST- 2023/03/21 06:00 [pubmed]
PHST- 2023/03/21 06:01 [medline]
PHST- 2023/03/14 00:00 [pmc-release]
AID - CCR36967 [pii]
AID - 10.1002/ccr3.6967 [doi]
PST - epublish
SO  - Clin Case Rep. 2023 Mar 14;11(3):e6967. doi: 10.1002/ccr3.6967. eCollection 2023 
      Mar.