title: Endoscopic localization and tattooing of a proinsulinoma for minimally invasive resection.
abstract: Hypoglycemia can be common in patients using insulin injections or certain antidiabetes medications. In rare cases, hypoglycemia can be caused by a pancreatic insulinoma. We report a case of a 33-year-old woman found to have severe recurrent hypoglycemia. Diagnostic studies such as continuous glucose monitoring and a hospitalized fast provided biochemical evidence for a proinsulinoma. After abdominal multidetector contrast-enhanced computerized tomography failed to detect pancreatic abnormalities, endoscopic ultrasonography identified and localized a 9-mm pancreatic tail lesion. At the time of endoscopy, the lesion was tattooed with ultrasonographic guidance for subsequent laparoscopic visualization and curative resection.
authors.affiliation: Johns Hopkins University, School of Medicine, Baltimore, MD, USA. arodrig5@jhmi.edu
authors.forename: Annabelle
authors.initials: A
authors.lastname: Rodriguez
authors.forename: Marcia I
authors.initials: MI
authors.lastname: Canto
authors.forename: Martin A
authors.initials: MA
authors.lastname: Makary
mesh_terms: D000328:Adult; D019160:Endosonography; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology; D007340:Insulinoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D010535:Laparoscopy; D019060:Minimally Invasive Surgical Procedures; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D013653:Tattooing