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Pancreatic neuroendocrine tumour—insulinoma masquerading as a psychiatric illness
  1. Jnanaprakash B Karanth1,
  2. Vishwas Pai2 and
  3. Kiran Maribashetti3
  1. 1General Medicine, Shripad Hegde Institute of Medical Sciences, Sirsi, Karnataka, India
  2. 2Oncosurgery, Shripad Hegde Institute of Medical Sciences, Sirsi, Karnataka, India
  3. 3Internal Medicine, Army Hospital Research and Referral, New Delhi, India
  1. Correspondence to Dr Kiran Maribashetti;{at}


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.

  • Psychiatry (drugs and medicines)
  • Pancreas and biliary tract
  • Endocrine cancer

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  • Contributors JBK interviewed and wrote the case report. VP and KM contributed, reviewed and finalised the case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.