Insulinoma

Case contributed by Dr Mostafa El-Feky

Presentation

The patient started a diet regimen for losing weight for the previous three months, currently presented with recurrent attacks of decreased concentration and fainting. Fasting blood glucose level 35 mg/dL.

Patient Data

Age: 45 years
Gender: Female
CT

An oval-shaped nodular lesion is noted at the inferior aspect of the mid-body of the pancreas measuring 2 x 1 cm in axial dimensions. It shows avid homogeneous hyperenhancement in the arterial phase with complete equilibration at the venous and delayed phases.

MRI

A small T2 hyperintense oval-shaped lesion is noted at the anteroinferior aspect of the body of the pancreas. It is best demonstrated onT2 fat sat sequence, as onT2 it is iso-intense to the surrounding fat.

Case Discussion

The features are those of a hypervascular pancreatic lesion, likely representing an endocrine pancreatic tumor. Regarding the patient presentation of hypoglycemia, insulinoma may be considered. Insulinoma is usually suspected clinically on the basis of Whipple's triad, which consists of fasting hypoglycemia <50 mg/dL, symptoms of hypoglycemia and immediate relief of symptoms after the administration of IV glucose.

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Case information

rID: 65654
Published: 19th Feb 2019
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: Dar El Ashaa Center

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