title: [Recurrent hypoglycemia due to an occult insulinoma].
abstract: A 64-year-old woman presented with a history of recurrent hypoglycemia. A prolonged fasting test revealed an increased "amended" insulin-glucose ratio. Transabdominal ultrasound (US), computed tomography (CT) scan, and magnetic resonance imaging (MRI) did not show abnormal results. An insulinoma was suspected based on a contrast-enhanced endoscopic US examination as well as a (68)gallium-DOTA-exendin-4 positron-emission tomography (PET)/CT. The diagnosis of an insulinoma was confirmed histologically after surgical removal of the tumor. Hypoglycemia did not occur during the postoperative period. The prolonged fasting test is the gold standard for the diagnosis of an insulinoma. Novel imaging procedures, such as contrast-enhanced endoscopic US or (68)gallium-DOTA-exendin-4 PET/CT are valuable additions to the diagnostic workup.
authors.affiliation: Abteilung für Diabetologie, Medizinische Klinik I, St. Josef-Hospital, Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland.
authors.forename: T G K
authors.initials: TG
authors.lastname: Breuer
authors.affiliation: Klinik für Allgemein- und Viszeralchirurgie, St. Josef-Hospital, Ruhr-Universität Bochum, Bochum, Deutschland.
authors.forename: H L
authors.initials: HL
authors.lastname: Breuer
authors.affiliation: Abteilung für Diabetologie, Medizinische Klinik I, St. Josef-Hospital, Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland.
authors.forename: B A
authors.initials: BA
authors.lastname: Menge
authors.affiliation: Abteilung für Diabetologie, Medizinische Klinik I, St. Josef-Hospital, Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Giese
authors.affiliation: Klinik für Allgemein- und Viszeralchirurgie, St. Josef-Hospital, Ruhr-Universität Bochum, Bochum, Deutschland.
authors.forename: W
authors.initials: W
authors.lastname: Uhl
authors.affiliation: Abteilung für Diabetologie, Medizinische Klinik I, St. Josef-Hospital, Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland.
authors.forename: W E
authors.initials: WE
authors.lastname: Schmidt
authors.affiliation: Institut für Pathologie, Ruhr-Universität Bochum, Bochum, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Tannapfel
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsspital Basel, Basel, Schweiz.
authors.forename: D
authors.initials: D
authors.lastname: Wild
authors.affiliation: Abteilung für Diabetologie, Medizinische Klinik I, St. Josef-Hospital, Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland.
authors.forename: M A
authors.initials: MA
authors.lastname: Nauck
authors.affiliation: Abteilung für Diabetologie, Medizinische Klinik I, St. Josef-Hospital, Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland. juris.meier@rub.de.
authors.forename: J J
authors.initials: JJ
authors.lastname: Meier
mesh_terms: D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis* / Q000209:etiology*; D007340:Insulinoma / Q000150:complications* / Q000000981:diagnostic imaging*; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D012008:Recurrence
keywords: Endoscopic ultrasonography; Exendin-4; Positron-emission tomography; Prolonged fasting test