Pancreatic neuroendocrine tumour-insulinoma masquerading as a psychiatric illness

A female patient in her early sixties had problems of recurrent syncopal attacks and panic attacks over the last 5 years. She had been initially managed for an anxiety disorder with psychiatric medications. During one of those episodes, she was brought to our hospital in an unconscious state with a low blood sugar level of 43 mg/dL. She was suspected to have a neuroendocrine tumour and diagnosis was established by supervised fasting up to 72 hours and imaging. Her recorded blood sugar during fasting was 37 mg/dL. She underwent surgery and presently remains asymptomatic. Physicians should have a high suspicion of insulinoma in patients presenting with repeated episodes of hypoglycaemic symptoms in the absence of any cognizable cause.