title: Ectopic insulin secreting neuroendocrine tumor of kidney with recurrent hypoglycemia: a diagnostic dilemma.
abstract: BACKGROUND
  Hypoglycemia secondary to ectopic insulin secretion of non-pancreatic tumors is rare.
  
  
  METHODS
  We describe a middle aged woman with recurrent hypoglycemia. On evaluation, she was detected to have hyperinsulinemic hypoglycemia and right sided renal mass lesion. 68Ga-Dotanoc and 99mTc-HYNICTOC scans confirmed the intrarenal mass to be of neuroendocrine origin. Right nephrectomy was done and it turned out to be an insulin secreting neuroendocrine tumour. Neuroendocrine nature of this tumour was further confirmed by ultra-structural examination. Her hypoglycemia did not recur after resection of this tumour.
  
  
  CONCLUSIONS
  Few cases of ectopic insulin secretion have been reported though some are not proven convincingly. This case addresses all the issues raised in previous case reports and proves by clinical, laboratory, functional imaging and immunohistochemical analysis that ectopic origin of insulin by non-pancreatic tumors does occur. To our knowledge, this is the first reported case of ectopic insulinoma arising from the kidney.
authors.forename: S
authors.initials: S
authors.lastname: Ramkumar
authors.forename: Atul
authors.initials: A
authors.lastname: Dhingra
authors.affiliation: Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. vivekapjyotsna@yahoo.com.
authors.forename: Vp
authors.initials: V
authors.lastname: Jyotsna
authors.forename: Mohd Ashraf
authors.initials: MA
authors.lastname: Ganie
authors.forename: Chandan J
authors.initials: CJ
authors.lastname: Das
authors.forename: Amlesh
authors.initials: A
authors.lastname: Seth
authors.forename: Mehar C
authors.initials: MC
authors.lastname: Sharma
authors.forename: Chandra Sekhar
authors.initials: CS
authors.lastname: Bal
mesh_terms: D005260:Female; D006801:Humans; D006946:Hyperinsulinism / Q000175:diagnosis* / Q000209:etiology; D007003:Hypoglycemia / Q000175:diagnosis* / Q000209:etiology; D007328:Insulin / Q000378:metabolism*; D000078790:Insulin Secretion; D007340:Insulinoma / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D007680:Kidney Neoplasms / Q000150:complications* / Q000378:metabolism / Q000601:surgery; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects*; D018358:Neuroendocrine Tumors / Q000150:complications* / Q000378:metabolism / Q000601:surgery; D009942:Organometallic Compounds; D049268:Positron-Emission Tomography; D011379:Prognosis
chemical_list: C504894:68Ga-DOTANOC; D007328:Insulin; D009942:Organometallic Compounds
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