title: Metastatic insulinoma in a patient with type 2 diabetes mellitus: case report and review of the literature.
abstract: Pancreatic neuroendocrine tumors (NETs) are extremely rare, and although insulinomas are the commonest, less than 10% of insulinomas are malignant. Most patients with insulinomas present with neuroglycopenic symptoms and weight gain attributable to insulin excess. Here, we report a case where a 67-year-old lady with a background history of type 2 diabetes mellitus and breakthrough hyperinsulinism who presented with coma. The biochemical profile revealed features typical of insulinoma, and CT and endosonography confirmed a pancreatic tumor with large volume right-sided liver metastases (biopsy confirming a neuroendocrine tumor). The patient underwent successful one-step RO surgical resection, distal pancreatectomy, splenectomy, and right hepatectomy, and 9 months postoperatively, she remains free of recurrent disease. She remains a diabetic.
authors.affiliation: Department of Endocrinology, St. James' Hospital, Dublin 8, Ireland.
authors.forename: Noormuhammad Oosman
authors.initials: NO
authors.lastname: Abbasakoor
authors.forename: Marie Louise
authors.initials: ML
authors.lastname: Healy
authors.forename: Donal
authors.initials: D
authors.lastname: O'Shea
authors.forename: Donal
authors.initials: D
authors.lastname: Maguire
authors.forename: Cian
authors.initials: C
authors.lastname: Muldoon
authors.forename: Kieran
authors.initials: K
authors.lastname: Sheahan
authors.forename: Dermot
authors.initials: D
authors.lastname: O'Toole