title: A rare case of hypoglycaemia due to insulinoma in an adolescent with acutely altered mental status.
abstract: BACKGROUND
  Multiple endocrine neoplasia type 1 (MEN1) is an inherited neoplasia syndrome that generally presents with hypercalcaemia due to hyperparathyroidism. Insulin-producing tumours are less common components of the syndrome that emerge later during the course of the disease. We report here a case of an adolescent who presented with symptomatic hypoglycaemia as the first indication of MEN1.
  
  
  METHODS
  A 14-year-old boy, known to use illicit drugs, was brought to the hospital with altered mental status. He was hypoglycaemic and further investigations revealed two pancreatic insulinomas. Despite having no relevant family history, genetic evaluation showed a mutation consistent with MEN1.
  
  
  CONCLUSIONS
  Insulinomas in adolescents are generally rare and even less common as a first presentation of MEN1. This diagnosis carries implications for potential future neoplasms, both benign and malignant. While intoxication is a more common case of altered mental status in adolescents, clinicians must maintain a high index of suspicion for organic disease.
authors.forename: Karin Y
authors.initials: KY
authors.lastname: Winston
authors.forename: Jonathan
authors.initials: J
authors.lastname: Dawrant
mesh_terms: D000293:Adolescent; D006801:Humans; D006946:Hyperinsulinism / Q000150:complications; D007003:Hypoglycemia / Q000209:etiology*; D007340:Insulinoma / Q000150:complications* / Q000601:surgery; D008297:Male; D001523:Mental Disorders / Q000209:etiology; D018761:Multiple Endocrine Neoplasia Type 1 / Q000150:complications*; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000601:surgery