Altered mental state and the Whipple triad

Area of Science:

• Endocrinology
• Neurosurgery
• Diagnostic Imaging

Background:

• Insulinomas are rare pancreatic neuroendocrine tumors causing hypoglycemia.
• Altered mental states can be a presenting symptom of severe hypoglycemia.
• Accurate tumor localization is crucial for successful surgical management.

Purpose of the Study:

• To report a case of insulinoma presenting as altered mental state.
• To highlight the diagnostic challenges and localization techniques for insulinoma.
• To discuss the surgical management and long-term outcomes.

Main Methods:

• Clinical presentation and diagnostic workup.
• Imaging studies including computed tomography (CT) scan.
• Intraoperative laparoscopy and selective venous sampling for tumor localization.
• Surgical resection of the insulinoma.
• Post-operative follow-up for recurrence.

Main Results:

• A 47-year-old male presented with symptoms initially misdiagnosed as seizures, later identified as hypoglycemia.
• Insulinoma was confirmed biochemically and localized using selective venous sampling after initial imaging and laparoscopy.
• Successful surgical resection was performed.
• No evidence of tumor recurrence was observed at 15 months post-surgery.

Conclusions:

• Insulinoma can present with non-specific neurological symptoms like altered mental state.
• Multimodality diagnostic approaches, including selective venous sampling, are essential for insulinoma localization.
• Surgical management offers a curative option for insulinoma with good long-term prognosis.