Clinical Diabetes 22:102-104, 2004
© American Diabetes Association ®, Inc., 2004
Case Study: An 82-Year-Old Woman Presents With Severe Hypoglycemia Induced by an Insulinoma
Saleemah Yasmeen Fahmi, MD and
Philip Raskin, MD
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Presentation
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I.H. is an 82-year-old white woman who presented to her primary care physician with a 10-year history of episodic confusion and somnolence. The episodes occurred about twice a year, typically in the morning, just after waking. They lasted minutes and were relieved when she ate her breakfast or had juice. Over the 8–10 months before presentation, the patient noted that the episodes were increasing in frequency as well as occurring throughout the day.
When I.H. presented to her primary care doctor with the above complaints, the patient was reassured. As she was waiting for check-out, she developed confusion, a capillary blood glucose test was performed, and she was noted to have a plasma glucose level of 28 mg/dl. She was given juice and her symptoms resolved after a few moments.
The patient was subsequently admitted to the hospital for further work up.
On exam, I.H. was found to be a well-nourished woman in no apparent distress. Her vital signs were significant only for mild hypertension. Her physical and neurological exams were unremarkable. Her admission lab values were significant for a glucose level of 36 mg/dl. She was completely asymptomatic upon presentation and was thus placed on a fasting protocol. Subsequent laboratory results are listed in Table 1.
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Table 1. Laboratory Results for Patient I.H. on Fasting Protocol
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In this case (as is true in most centers), the serum insulin, serum C-peptide, and sulfonylurea levels were not readily available. Therefore, the fasting protocol was continued until she became symptomatic. The subsequent lab results were consistent with the suspected diagnosis of an insulin secreting tumor. To localize the tumor, I.H. had an abdominal CT with contrast, which revealed an enhancing mass in the pancreatic head suggestive of an insulinoma (Figure 1).
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Figure 1. Contrasted abdominal CT scan . . . [Full Text of this Article] |
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Questions
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Commentary
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Clinical Pearls
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Copyright © 2004 by the American Diabetes Association.
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