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Insulinoma presenting with cardiac arrest and cardiomyopathy

Arthi Thirumalai1, Ximena A Levander, Somnath Mookherjee

  • 1Internal Medicine Residency Program, University of Washington, Seattle, Washington, USA.

BMJ Case Reports
|October 25, 2013
PubMed

Insights

A rare case of insulinoma caused severe hypoglycemia, leading to cardiac arrest and dilated cardiomyopathy. Surgical removal of the pancreatic tumor cured hypoglycemia and improved heart function.

Area of Science:

  • Cardiology
  • Endocrinology
  • Oncology

Background:

  • Insulinoma, a rare pancreatic tumor, causes hyperinsulinemic hypoglycemia.
  • Hypoglycemia can precipitate cardiac events and myocardial dysfunction.
  • Dilated cardiomyopathy is a serious cardiac condition with various potential causes.

Observation:

  • A 33-year-old woman presented with ventricular fibrillation cardiac arrest and severe hypoglycemia (1.83 mmol/L).
  • Cardiac catheterization revealed dilated cardiomyopathy with reduced ejection fraction (26%) and normal coronary arteries.
  • Continuous dextrose infusion was necessary, suggesting an underlying cause for hypoglycemia and cardiomyopathy.

Findings:

  • Whipple's triad was confirmed, and a 72-hour fast provided biochemical evidence of insulinoma.
  • Imaging localized a pancreatic tumor, which was resected and confirmed as insulinoma.
  • Pancreaticoduodenectomy cured the hypoglycemia, and the patient's ejection fraction improved to 41% within 4 months.

Implications:

  • This case highlights insulinoma as a potential cause of unexplained dilated cardiomyopathy and cardiac arrest.
  • High insulin levels may directly affect cardiac function by closing K(ATP) channels.
  • Hypoglycemia-induced catecholamine surges and QT prolongation can contribute to ventricular remodeling and arrhythmias.

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