Neuropsychiatric profiles of patients with insulinomas.
OBJECTIVE
Insulinoma is a rare and potentially curable disease. It is often misdiagnosed as neurological or psychiatric disorder. This study was performed to characterize the neuropsychiatric symptoms (PNS) of the patients with insulinoma from a regional clinical center.


METHODS
All medical records of the patients with histopathologically identified insulinoma were reviewed during the period from 1998 to 2008. A case-control analysis was performed to compare the demographic data, details of clinical presentation, biochemical findings, tumor localization, and intraoperative findings between the patients with and without a prior misdiagnosis.


RESULTS
Among 42 patients with insulinoma, 25 patients with PNS were initially misdiagnosed as having a neurological or psychiatric disease, while 17 patients with no PNS were correctly diagnosed. Most (64%) of PNS cases were not diagnosed correctly until 12 months after the first consultation. In patients with PNS that remained undiagnosed for at least 5 years, the most frequent symptoms were confusion, convulsion, and visual disturbances. Twelve cases of PNS were initially misdiagnosed as epilepsy and 3 of them showed epileptiform discharges on electroencephalography.


CONCLUSIONS
Episodic hypoglycemia induced by insulinoma can greatly mimic neurological and psychiatric presentation. A thorough history taking and inpatient assessment are necessary in evaluating recurrent neurological and psychiatric symptoms.
Ding
Yao
Y
Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Wang
Shuang
S
Liu
Jianren
J
Yang
Yi
Y
Liu
Zhirong
Z
Li
Jufeng
J
Zhang
Bo
B
Chen
Ying
Y
Ding
Meiping
M
D000328:Adult; D001921:Brain / Q000473:pathology / Q000503:physiopathology; D016022:Case-Control Studies; D003951:Diagnostic Errors; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007340:Insulinoma / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D012189:Retrospective Studies; D013997:Time Factors