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Insulinoma with equivocal imaging.

Wafa Belabed¹, Fatma Mnif¹, Abdel Mouhaymen Missaoui¹

¹Department of Endocrinology and Diabetology, Hedi Chaker University Hospital, Sfax, Tunisia.

Endocrinology, Diabetes & Metabolism Case Reports

|May 25, 2023

Summary

A patient with endogenous hyperinsulinemic hypoglycemia underwent surgery for a suspected insulinoma. Successful left pancreatectomy confirmed a neuroendocrine tumor, resolving the patient's symptoms.

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Area of Science:

Endocrinology
Surgical Oncology
Diagnostic Imaging

Background:

Endogenous hyperinsulinemic hypoglycemia can be caused by insulinoma, a rare pancreatic tumor.
Accurate preoperative localization of pancreatic masses is crucial for effective surgical planning.
Interpreting somatostatin receptor scintigraphy requires vigilance due to potential physiological uptake in the uncinate process.

Purpose of the Study:

To report a case of successful surgical management of an insulinoma.
To highlight the diagnostic challenges and effective localization methods for insulinoma.

Main Methods:

A 55-year-old patient with recurrent altered consciousness was investigated.
Diagnostic workup included computed tomography, endoscopic ultrasound, somatostatin receptor scintigraphy, and magnetic resonance imaging.

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Surgical localization involved intraoperative manual palpation and ultrasonography, followed by left pancreatectomy.

Main Results:

Initial imaging was inconclusive for precise tumor localization.
Somatostatin receptor scintigraphy showed uptake in both the pancreatic tail and uncinate process.
Intraoperative findings confirmed a single 1.5 cm lesion in the pancreatic body, leading to successful resection.
Histopathology confirmed a well-differentiated neuroendocrine tumor (insulinoma).

Conclusions:

Left pancreatectomy effectively treated the patient's insulinoma, with immediate symptom resolution.
Intraoperative palpation and ultrasonography are highly effective for insulinoma localization during surgery.
Radiological interpretation, particularly of somatostatin receptor scintigraphy, requires careful consideration of physiological variations.