Article Text

Download PDFPDF
CASE REPORT
Insulinoma presenting with cardiac arrest and cardiomyopathy
  1. Arthi Thirumalai1,
  2. Ximena A Levander1,
  3. Somnath Mookherjee2,
  4. Andrew A White2
  1. 1Internal Medicine Residency Program, University of Washington, Seattle, Washington, USA
  2. 2Department of Medicine, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Somnath Mookherjee, smookh{at}u.washington.edu

Summary

A 33-year-old woman presented with ventricular fibrillation cardiac arrest and was found to have a blood glucose of 1.83 mmol/L. Cardiac catheterisation revealed a dilated left ventricle with an ejection fraction (EF) of 26% and angiographically normal coronary arteries. Continuous dextrose infusion was required to treat hypoglycaemia, which prompted consideration of insulinoma as a possible cause for her cardiomyopathy. Whipple's triad was demonstrated; a 72 h fast provided biochemical evidence of insulinoma, and imaging localised a tumour in her pancreas. The tumour was resected and pathology confirmed insulinoma; pancreaticoduodenectomy cured her hypoglycaemia. No alternate cause of cardiomyopathy was found and 4 months after surgery her EF improved to 41%. High insulin levels can close cardiac KATP channels associated with dilated cardiomyopathy; the catecholamine surge from hypoglycaemia may also contribute to ventricular remodelling. Hypoglycaemia can cause QT segment prolongation, and may have precipitated fibrillation in this patient's arrhythmia-prone myocardium.

Statistics from Altmetric.com

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.