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