A Rare Cause of Hypoglycemia in Elderly Patients: Insulinoma

Abstract

Insulinoma is the most common pancreatic neuroendocrine tumor and is often solitary and benign. To make a diagnosis, high insulin levels must be demonstrated, and proinsulin and C-peptide measurements must be done. The presence of hypoglycemic measurements and symptoms in the 72-hour fasting test is diagnostic. We present a case of a 91-year-old patient with no known diagnosis of diabetes mellitus who was admitted to the emergency department due to confusion. As a result of the clinical evaluation and differential diagnosis, it was determined that her complaint was due to hypoglycemia, and she was admitted to the internal medicine service for further examination, diagnosis, and treatment.

Keywords: hypoglycemia; insulinoma; kimura technique; spleen-preserving distal pancreatectomy; whipple's triad.

Figure 1. Contrast-enhanced CT scan of the abdomen.

The white arrow points to the nodular lesion located in the tail of the pancreas. (A) Axial view. (B) Coronal view.

Figure 2. Gallium 68 uptake in the tail of the pancreas. The white arrow points to the nodular lesion (positron emission tomography view).

Figure 3. The white arrow points to the nodular lesion located in the tail of the pancreas.

(A) Intraoperative view. (B) Surgical specimen.