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Related Experiment Videos

Insulinoma masquerading as factitious hypoglycemia

J W Baddley1, D Daberkow, C W Hilton

  • 1Department of Medicine, Louisiana State University Medical Center, New Orleans 70112, USA.

Southern Medical Journal
|November 21, 1998
PubMed
Summary

A woman experienced spells of vision problems, fatigue, and dizziness due to low blood sugar. Further tests revealed multiple insulinomas, a rare cause of hypoglycemia, not factitious drug use.

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Area of Science:

  • Endocrinology
  • Oncology
  • Surgical Pathology

Background:

  • Hypoglycemia can present with non-specific symptoms like diplopia, fatigue, and dizziness.
  • Factitious hypoglycemia is a potential diagnosis, often suggested by a positive sulfonylurea screen.

Observation:

  • A 36-year-old woman presented with spells of diplopia, fatigue, and dizziness.
  • Fasting laboratory results showed hypoglycemia (glucose 40 mg/dL), elevated insulin (15 microU/mL), and C-peptide (2.5 ng/mL).
  • An initial sulfonylurea screen was positive for tolbutamide.

Findings:

  • Despite the positive sulfonylurea screen, further investigation revealed multiple pancreatic masses.
  • Surgical confirmation established the diagnosis of multiple insulinomas as the cause of endogenous hyperinsulinism.

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  • This case highlights the importance of comprehensive workup beyond initial screening tests.

    • Implications:

    • Distinguishing between factitious and endogenous hypoglycemia is critical for appropriate management.
    • Multiple insulinomas, though rare, must be considered in cases of unexplained hyperinsulinemic hypoglycemia.
    • Surgical intervention is key for diagnosing and treating insulinomas.