Case contributed by Mohamed Saber


Refractory attacks of hypoglycemia

Patient Data

Age: 20 years
Gender: Male

Multiphasic CT study shows a well-defined pancreatic body/ tail focal lesion measures about 1.5 cm, presents vivid homogenous arterial enhancement with mild persistent enhancement at redistribution phases. Left adrenal small well-defined soft tissue mass lesion is also noted

Case Discussion

This patient was complaining of refractory hypoglycemia with very low blood sugar readings that occasionally reaching 30 mg/dl. Insulinomas are the most common sporadic neuroendocrine tumors of the pancreas.

Pancreatic islet-cell tumors are one of the main components of multiple endocrine neoplasia type I together with pituitary and parathyroid tumors. Adrenal cortical lesions may associate MEN type I. In this case, the presence of pancreatic islet cell tumor associated with the left adrenal lesion is concerning MEN type I, and imaging & lab assessment of pituitary and parathyroid glands should be conducted.

Contributions by Dr. Mohamed Elthokaby

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