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CASE REPORT
Concurrent insulinoma and impaired glucose tolerance suspected as owing to obesity
  1. Katsumi Iizuka,
  2. Taro Fujisawa,
  3. Jun Takeda
  1. Diabetes and Endocrinology, Graduate School of Medicine, Gifu University, Gifu, Japan
  1. Correspondence to Dr Katsumi Iizuka, kiizuka{at}gifu-u.ac.jp

Summary

An obese 68-year-old woman was admitted for examination of fasting hypoglycaemia. A prolonged 18 h fast reduced her plasma glucose without suppressing insulin secretion, while plasma β-hydroxybutyrate levels were suppressed. Despite the prolonged fast, the glucose response to glucagon was increased by 25 mg/dL (1.39 mM) glucose, which is compatible with insulinoma. A 75 g oral glucose tolerance test (75 g OGTT) showed impaired glucose tolerance. An abdominal CT scan revealed a mass lesion in the uncinate process of the pancreas, a finding consistent with the results of angiography and selective artery calcium injection test. The patient then underwent a pancreaticoduodenectomy; the pancreatic mass was histologically diagnosed as benign insulinoma. After surgery, a prolonged 24 h fast caused no hypoglycaemia and the glucose tolerance capacity in 75 g OGTT improved. Eight months after surgery, the patient's body weight had reduced by 10 kg. This is therefore a case of concurrent insulinoma and impaired glucose tolerance.

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