title: Intractable pruritus associated with insulinoma in the absence of multiple endocrine neoplasia: a novel paraneoplastic phenomenon.
abstract: Insulinoma is a rare tumour, the main symptoms of which are related to hypoglycaemia. Generalized pruritus has been described in association with the multiple endocrine neoplasia syndrome (MEN II or Sipple's syndrome) as a paraneoplastic phenomenon. Further, pruritus is known to be part of the paraneoplastic syndrome in other solid tumours. This case describes a patient presenting with symptoms of Whipple's triad (hypoglycaemic symptoms during fasting, low fasting blood sugar levels and symptoms relieved by intravenous dextrose). Magnetic resonance scanning and selective mesenteric angiography demonstrated a probable pancreatic neuroendocrine tumour. Pituitary fossa imaging and endocrine profile excluded the MEN I syndrome. Symptoms resolved after surgical removal of the tumour. Histology confirmed a pancreatic neuroendocrine tumour. The association between pruritus and insulinoma appears to be a novel paraneoplastic phenomenon.
authors.affiliation: Dept. of Histopathology, University Hospital of South Manchester, Withington, Manchester, UK.
authors.forename: N K K
authors.initials: NK
authors.lastname: King
authors.forename: H P P
authors.initials: HP
authors.lastname: Siriwardana
authors.forename: J D
authors.initials: JD
authors.lastname: Coyne
authors.forename: A K
authors.initials: AK
authors.lastname: Siriwardena
mesh_terms: D005260:Female; D006801:Humans; D007340:Insulinoma / Q000150:complications* / Q000175:diagnosis; D018810:Magnetic Resonance Angiography; D008875:Middle Aged; D009377:Multiple Endocrine Neoplasia / Q000150:complications; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000175:diagnosis; D010257:Paraneoplastic Syndromes; D011537:Pruritus / Q000209:etiology*