title: A malignant cause of hypoglycaemia: a metastatic insulin-secreting pancreatic neuroendocrine carcinoma.
abstract: Most cases of insulinomas are benign. We report a case of a malignant form of insulinoma. A 46-year-old man presented with behavioural changes associated with hypoglycaemia. Diagnostic work up revealed high serum insulin, high C-peptide and low glucose levels, compatible with endogenous hyperinsulinaemic hypoglycaemia. CT imaging of the abdomen revealed a pancreatic head mass and multiple liver masses. Biopsy of the pancreatic mass revealed a grade three pancreatic neuroendocrine carcinoma. Histological analysis of a liver mass showed that it was identical to the pancreatic mass, confirming its metastatic nature. The patient underwent distal pancreatectomy with en bloc splenectomy. There was persistence of hypoglycaemic symptoms after removal of the pancreatic mass, suggesting that the liver metastases were also functioning. Symptoms were controlled by diazoxide and octreotide long-acting release. The patient is already 1 year postsurgery with no recurrence of severe hypoglycaemia, and he has good functional capacity and has returned to his office job.
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines Department of Physiology, College of Medicine, University of the Philippines Manila, Manila, Philippines.
authors.forename: Mark Anthony
authors.initials: MA
authors.lastname: Sandoval
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
authors.forename: Daveric
authors.initials: D
authors.lastname: Pagsisihan
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, College of Medicine and Philippine General Hospital, Manila, Philippines.
authors.forename: A'Ericson
authors.initials: A
authors.lastname: Berberabe
authors.affiliation: Department of Medicine, University of Perpetual Help-Dr Jose G Tamayo Medical Center, Binan, Laguna, Philippines.
authors.forename: Elaine Gayle
authors.initials: EG
authors.lastname: Palugod-Lopez
mesh_terms: D001706:Biopsy; D001786:Blood Glucose / Q000378:metabolism; D002096:C-Peptide / Q000378:metabolism; D018278:Carcinoma, Neuroendocrine / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D003981:Diazoxide / Q000627:therapeutic use; D006801:Humans; D006946:Hyperinsulinism / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D007003:Hypoglycemia / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D007328:Insulin / Q000097:blood / Q000378:metabolism*; D000078790:Insulin Secretion; D007340:Insulinoma / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use; D010179:Pancreas / Q000473:pathology* / Q000601:surgery; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology* / Q000601:surgery
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D007328:Insulin; D003981:Diazoxide; D015282:Octreotide