Insulinoma presenting with postprandial hypoglycemia and a low body mass index:A case report  

作　　者：Dana Prídavková Matej Samoš Roman Kyčina Katarína Adamicová Michal Kalman Margita Belicová Marián Mokáň 

机构地区：[1]Clinic of Internal Medicine Ⅰ,Comenius University in Bratislava,Jessenius Faculty of Medicine in Martin,Martin 03601,Slovakia [2]Clinic of Surgery and Transplant Center,Comenius University in Bratislava,Jessenius Faculty of Medicine in Martin,Martin 03601,Slovakia [3]Department of Pathological Anatomy,Comenius University in Bratislava,Jessenius Faculty of Medicine in Martin,Martin 03601,Slovakia

出　　处：《World Journal of Clinical Cases》2020年第18期4169-4176,共8页世界临床病例杂志

摘　　要：BACKGROUND Insulinomas are the most common type of functioning endocrine neoplasms of the pancreas presenting hypoglycemic symptoms.Patients characteristically develop symptoms while fasting,but some patients have reported symptoms only in the postprandial state.Repeated and prolonged hypoglycemic episodes can reduce the awareness of adrenergic symptoms,and patients may have amnesia,which delays diagnosis.CASE SUMMARY We describe a case of a 24-year-old underweight patient who showed hypoglycemic symptoms for almost 6 years.Although patients with insulinoma characteristically develop symptoms while fasting,this young man had hypoglycemic symptoms up to one hour postprandially,especially after highsugar meals and after physical activity.The fasting tests and imaging methods performed at local hospitals were evaluated as negative for abnormal results.However,brown adipose tissue exhibited increased metabolic activity,and some muscle groups had histological changes as indicated by positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography.Glycogen deficiency was also histologically confirmed.The patient’s symptoms progressed over the years and occurred more frequently,i.e.,several times a month,and the patient had reduced awareness of adrenergic symptoms.The follow-up fasting test was positive,and the imaging results showed a tumor in the head of the pancreas.The patient underwent laparotomy with enucleation of the insulinoma.CONCLUSION Weight gain and fasting hypoglycemia are not necessarily characteristics of insulinoma.In prolonged cases,adrenergic symptoms can be suppressed.

关 键 词：Brown adipose tissue Glycogen deficit HYPOGLYCEMIA INSULINOMA UNDERWEIGHT Case report 

分 类 号：R735.9[医药卫生—肿瘤]