Article Text

Download PDFPDF
Reminder of important clinical lesson
Insulinoma presenting as postprandial hypoglycaemia
  1. Asgar Madathil1,
  2. Jola Weaver2
  1. 1Diabetes and Endocrinology Department, Gatesehad Health NHS Foundation Trust, Gateshead, Tyne and Wear, UK
  2. 2Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
  1. Correspondence to Dr Asgar Madathil, asgar.madathil{at}ncl.ac.uk

Summary

Although insulinoma commonly presents as fasting hypoglycaemia it can rarely present as postprandial hypoglycaemia. We describe a case of insulinoma presenting as postprandial hypoglycaemia and type 2 diabetes mellitus (T2DM). A 60-year-old man presented with a 6 year history of postprandial hypoglycaemic symptoms. A diagnosis of T2DM was made using a standard oral glucose tolerance test to which patient’s postprandial hypoglycaemia was attributed. He was given dietetic advice for postprandial hypoglycaemia and was followed up routinely. After 2 years, hypoglycaemic symptoms worsened by exercise and delayed meals. A number of supervised fasting glucose measurements failed to demonstrate biochemical hypoglycaemia. His insulin, c-peptide and pro-insulin levels were mildly elevated but plasma glucose levels were normal. A CT scan showed 20 mm lesion in the pancreas which was confirmed as insulinoma with pancreatic arterial calcium stimulation studies. Laparoscopic resection confirmed benign insulinoma and hypoglycaemia resolved. Our case illustrates the importance of considering insulinoma as a cause of postprandial hypoglycaemia.

View Full Text

Statistics from Altmetric.com

Footnotes

  • Competing interests None.

  • Patient consent Obtained.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.