title: Sporadic insulinoma in a 10-year-old boy: a case report and literature review.
abstract: BACKGROUND
  Insulinoma is an exceedingly uncommon pancreatic islet cell neuroendocrine tumor. Its estimated incidence is approximately four cases per million individuals per year.
  
  
  METHODS
  We report the case of sporadic insulinoma in an exceptionally very young 10-year-old boy who presented with a 1-month history of episodic tremulousness, diaphoresis, increased hunger, confusion and fainting. Initial laboratory investigations showed low blood glucose (64 mg/dL) and high blood insulin (6 μU/mL) levels. Patient was admitted in view of frequent hypoglycemic symptoms and possible pancreatic insulinoma. A 48-hour mentored fasting test was done and ceased within 3 hours due to occurrence of hypoglycemic symptoms. During the episode, blood was drawn and results showed low blood glucose level and high insulin, pro-insulin and C-peptide levels. The hypoglycemic symptoms were relieved greatly by glucose administration and Whipple's triad for insulinoma was met. An abdominal contrast-enhanced computed tomography scan showed a 10 x 12 x 17 mm, small, well-demarcated, heterogeneously enhancing lesion within the body of pancreas without dilatation of pancreatic duct. No evidence of lymphadenopathy or distant metastasis was identified. Patient underwent enucleation of pancreatic tumor. Histopathological and immunohistochemical examination of the pancreatic mass confirmed neuroendocrine tumor (insulinoma). Patient had an uneventful recovery. A post-operative 6-month follow-up showed resolution of hypoglycemic symptoms, normalized blood glucose, insulin, pro-insulin and C-peptide levels, and no evidence of recurrence.
  
  
  CONCLUSIONS
  Although rare, sporadic insulinoma should be considered in the differential diagnosis of any young individual presenting with frequent hypoglycemic symptoms (neuroglycopenic and/or autonomic nervous system symptoms). Furthermore, a literature review on insulinoma is presented.
authors.affiliation: College of Medicine, Alfaisal University. Riyadh, Saudi Arabia. aabuzaid@live.com.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abu-Zaid
authors.forename: Lama Abdulhamid
authors.initials: LA
authors.lastname: Alghuneim
authors.forename: Mona Tarek
authors.initials: MT
authors.lastname: Metawee
authors.forename: Ragaa Osama
authors.initials: RO
authors.lastname: Elkabbani
authors.forename: Hadeel
authors.initials: H
authors.lastname: Almana
authors.forename: Tarek
authors.initials: T
authors.lastname: Amin
authors.forename: Ayman
authors.initials: A
authors.lastname: Azzam
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D002096:C-Peptide / Q000097:blood; D002648:Child; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology; D007328:Insulin / Q000097:blood; D007340:Insulinoma / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008297:Male; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D012008:Recurrence; D014057:Tomography, X-Ray Computed
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D007328:Insulin