Episodic confusional state: Due to insulinoma

Area of Science:

• Neuroendocrinology
• Psychiatry
• Internal Medicine

Background:

• Episodic confusional states can stem from various underlying pathologies, often presenting diagnostic challenges.
• Neuroendocrine tumors, such as insulinoma, can manifest with diverse and sometimes atypical symptoms affecting mental status.
• The differential diagnosis for recurrent confusion and behavioral changes requires a broad clinical perspective.

Purpose of the Study:

• To report a rare case of insulinoma presenting as an episodic confusional state.
• To highlight the diagnostic difficulties associated with atypical presentations of insulinoma.
• To emphasize the importance of considering organic causes for psychiatric symptoms.

Main Methods:

• A case report detailing a 45-year-old male with recurrent episodes of confusion and disorganized behavior.
• Clinical observation and diagnostic workup, including computerized tomography scan and electroencephalogram, which were initially non-contributory.
• In-hospital observation during an acute episode, characterized by sweating and clouded consciousness, leading to the diagnosis.

Main Results:

• The patient experienced weekly episodes of confusion, disorganized behavior, and irrelevant talking for six months.
• Standard neurological investigations (CT scan, EEG) did not reveal the cause of the symptoms.
• Diagnosis of insulinoma was confirmed during an observed episode of intense sweating and clouded consciousness.

Conclusions:

• Insulinoma, a rare pancreatic neuroendocrine tumor, can present as an episodic confusional state.
• This case underscores the necessity of considering metabolic and endocrine disorders in the differential diagnosis of recurrent psychiatric symptoms.
• Prompt diagnosis and management of insulinoma are crucial to prevent potentially severe neurological and psychiatric manifestations.