title: Insulinoma diagnosed in the postpartum: clinical and immunohistochemical features.
abstract: Insulinomas are rare pancreatic β-cell tumors with an estimated incidence of 1:250.000 persons/year. We present a novel case of insulinoma manifesting immediately after childbirth. Eight days after delivery, a 21-year-old, previously healthy woman presented paresthesia in hands, upper and lower limbs muscle weakness with difficult walking, which worsened during breastfeeding sessions. Laboratory tests showed blood glucose levels between 37 and 55 mg/dL with inappropriately normal insulin levels (7.78 μUI/mL; normal range: 5-29). An abdominal computed tomography showed a nodular lesion measuring 2 cm at the head of the pancreas. Tumor enucleation resulted in complete resolution of hypoglycemia. Histopathological and immunohistochemical analysis were consistent with an insulinoma. About 27 cases of insulinoma associated with pregnancy have been reported to date, mostly diagnosed before the 16th week. The beginning of symptoms soon after delivery is less common. Understanding the interactions between pancreatic β-cell function and all the physiological metabolic and hormonal adaptations associated with gestation is essential for the adequate management of hypoglycemic disorders in pregnant women.
authors.affiliation: Ambulatory of Gonadal and Adrenal Diseases, Endocrinology Unit, University Hospital of Brasilia, Brazil.
authors.forename: Amadeu José
authors.initials: AJ
authors.lastname: Rodrigues Queiróz
authors.forename: Larissa Simões
authors.initials: LS
authors.lastname: Nazareno
authors.forename: Jane Eyre
authors.initials: JE
authors.lastname: Miranda
authors.forename: Ana Emília Borges
authors.initials: AE
authors.lastname: de Azevedo
authors.forename: Carlos Augusto
authors.initials: CA
authors.lastname: Teixeira da Cruz
authors.forename: Fabiana
authors.initials: F
authors.lastname: Pirani Carneiro
authors.forename: Augusto Cézar
authors.initials: AC
authors.lastname: Florêncio da Costa
authors.forename: Adriana
authors.initials: A
authors.lastname: Lofrano-Porto
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007340:Insulinoma / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D007774:Lactation; D018908:Muscle Weakness / Q000209:etiology; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D010292:Paresthesia / Q000209:etiology; D049590:Postpartum Period; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult