[A 64-year-old female patient with recurring hypoglycaemia. Difficult aspects of diagnosis].
Insulinomas are the most common pancreatic islet cell tumours and are characterised by uncontrolled insulin secretion even in the presence of hypoglycaemia. Diagnosis is usually made by the detection of endogenous hyperinsulinism over a period of fasting. We report the case of a patient with insulinoma without hyperinsulinaemia. A secretion and overexpression of split insulin has to be discussed. The diagnosis was made by endoscopic ultrasound-guided fine-needle aspiration and the immunohistochemical detection of chromogranine. In conclusion, the present report demonstrates that insulinomas should be considered and searched for in every case of hypoglycaemia, even when associated with normal insulin levels. It also confirms the essential role of endoscopic ultrasonography in the diagnosis of insulin-secreting tumors.
Hunger-Dathe
W
W
Klinik für Innere Medizin III, Friedrich-Schiller-Universität Jena, 07740, Jena, Deutschland. wilgard.hunger-dathe@med.uni-jena.de
Hocke
M
M
Sämann
A
A
Müller
U A
UA
Wolf
G
G
Gajda
M
M
D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006946:Hyperinsulinism / Q000175:diagnosis*; D007003:Hypoglycemia / Q000175:diagnosis*; D007340:Insulinoma / Q000175:diagnosis*; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis*
Transplantation. 2002 Feb 15;73(3):386-94
11884935
Langenbecks Arch Surg. 2005 Apr;390(2):134-40
15609056
Horm Res. 2001;56 Suppl 1:67-72
11786689
Dtsch Med Wochenschr. 2004 Apr 23;129(17):941-6
15083396
Br J Cancer. 1998 Oct;78(8):1102-7
9792158
Clin Endocrinol (Oxf). 2004 May;60(5):644-52
15104570
Hum Pathol. 2001 Oct;32(10):1094-101
11679944
Endokrynol Pol. 2005 May-Jun;56(3):302-7
16350723
Endocrinol Metab Clin North Am. 1999 Sep;28(3):533-54
10500930
ANZ J Surg. 2001 Aug;71(8):475-82
11504292
Med Clin (Barc). 2002 Feb 23;118(6):201-4
11864541
World J Surg. 1990 May-Jun;14(3):393-8; discussion 398-9
1973323
Mayo Clin Proc. 1991 Jul;66(7):711-9
1677058
Zentralbl Chir. 2001 Apr;126(4):273-8
11370388
Endocr J. 2002 Aug;49(4):517-22
12402985
Eur J Endocrinol. 2003 Nov;149(5):413-9
14585087
Surgery. 1998 Dec;124(6):1134-43; discussion 1143-4
9854595
Scand J Gastroenterol. 1998 Jan;33(1):109-12
9489918
Endoscopy. 1996 Mar;28(3):273-6
8781789
Rev Assoc Med Bras (1992). 2004 Apr-Jun;50(2):167-71
15286865
Arch Surg. 1992 Apr;127(4):442-7
1558498
Surgery. 1994 Dec;116(6):1131-8
7985098