Presentation
Repeated attacks of hypoglycemia. Fasting plasma glucose level at 25 mg/dL.
Patient Data
Small well-defined hypoechoic pancreatic nodule with internal vascularity on color doppler.
Small rounded relatively well-defined lesion of the pancreatic neck (12 mm). It elicits a low signal to the normal pancreatic tissue on T1, iso-to slight high signal on T2 with vivid enhancement on arterial phase, mild persistent enhancement on portal phase and complete equilibration on delayed phase.
The remainder of the abdomen is unremarkable.
Case Discussion
The clinical presentation and ultrasound and MRI features are most consistent with an endocrine pancreatic tumor, most likely an insulinoma.
Typically insulinomas present with Whipple's triad consisting of:
- fasting hypoglycemia (<50 mg/dL)
- symptoms of hypoglycemia
- immediate relief of symptoms after the administration of IV glucose