title: Rare among the rarities--recurrent insulinoma.
abstract: A patient with recurrent insulinoma without co-existing multiple endocrine neoplasia syndrome is described. In a 32-year-old man with recurrent episodes of symptomatic hypoglycemia, the supervised fast showed high insulin (24.5 IU/ml) and C-peptide level (3.06 ng/ml) with low blood sugar (27 mg/dl). A 1 x 1.5 cm nodule from the lower part of pancreatic body was removed on exploratory laparotomy. Histopathology confirmed the diagnosis of islet cell tumor. After 11 years, he started experiencing symptomatic hypoglycemic episodes with inappropriately elevated serum insulin and C-peptide levels (2.2 ng/ml). On pancreatic angiography, a 16 x 11 mm size tumor blush was noted. Due to fibrosis from previous surgery, distal pancreatectomy along with splenectomy was done. Histopathology confirmed the diagnosis of insulinoma. On both occasions, workup for multiple endocrine neoplasia turned out to be negative. He was given small amounts of intermediate acting insulin in early postoperative period, which was discontinued shortly thereafter.
authors.affiliation: Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, Aga Khan University Hospital, Stadium Road, Karachi-74800. aishasheikh2001@yahoo.com
authors.forename: Aisha
authors.initials: A
authors.lastname: Sheikh
authors.forename: Lubna
authors.initials: L
authors.lastname: Zuberi
authors.forename: Naeemul
authors.initials: N
authors.lastname: Haque
mesh_terms: D000328:Adult; D000792:Angiography; D001786:Blood Glucose / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D007328:Insulin / Q000097:blood; D007340:Insulinoma / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D009364:Neoplasm Recurrence, Local; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D013156:Splenectomy
chemical_list: D001786:Blood Glucose; D007328:Insulin; D002097:C-Reactive Protein