An insulinoma without fasting hypoglycemia.
A patient with a 25-year history of episodic irritability, confusion, and unconsciousness was suspected of having organic hypoglycemia. He was fasted for a 72-hour period without developing symptoms. At the end of the fast his blood sugar was 85 mg/100 ml and the immunoreactive insulin (IRI) concentraion was elevated to 350 microunits/ml. Surgical exploration demonstrated a 4 x 3 centimeter insulinoma in the tail of the pancreas. Since proinsulin-like components (PLC) are known to be elevated in patients with islet cell tumors and have only 5 to 10 per cent of the biologic activity of insulin, it is suggested that a major portion of the IRI was PLC. This case demonstrates that the inability to withstand prolonged fasting does not exclude the diagnosis of an insulinoma and suggests a mechanism whereby such patients can tolerate fasting.
D007516:Adenoma, Islet Cell / Q000378:metabolism*; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D005215:Fasting; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology*; D007328:Insulin / Q000378:metabolism; D008297:Male; D010190:Pancreatic Neoplasms / Q000378:metabolism*; D011384:Proinsulin / Q000378:metabolism
D001786:Blood Glucose; D007328:Insulin; D011384:Proinsulin