[Peripheral neuropathy and insulinoma (author's transl)]

A case of insulinoma is reported with disease of the peripheral nervous system and pathological demonstration of a primary nerve lesion. On admission the female patient gave a history of hypoglycemic episodes and paresthesias and loss of strength in both hands. Physical examination disclosed loss of strength and atrophy of the distal musculature of the extremities, predominating in the upper ones and without fasciculations. Muscle biopsy demonstrated changes suggestive of neurogenous atrophy, and biopsy of the sural nerve showed reduction of the myelin fibers with axonal degeneration, important signs of demyelinization, and remyelinization figures. The neuropathy was unchanged two months after removal of the insulinoma. The exact location of the nerve lesion in insulinoma is controversial, some authors placing it in the peripheral nerve while others believe the motor neurons of the anterior horns to be diseased. The pathological findings in the present case suggest primary nerve disease, but an associated lesion of the anterior horns could also be present.