Logo American Journal of Case Reports

Call: 1.631.629.4328
Mon-Fri 10 am - 2 pm EST

Contact Us

Logo American Journal of Case Reports Logo American Journal of Case Reports Logo American Journal of Case Reports

14 June 2020 : Case report  USA

Changing Insulinoma Management Due to Incidentally Discovered Metastasis: A Case Report

Rare disease

Riya Madan1ABCDEF*, Tetyana Mettler2D, Jerry Froelich3D, Lisa S. Chow4AEF

DOI: 10.12659/AJCR.923356

Am J Case Rep 2020; 21:e923356

Abstract

BACKGROUND: Hypoglycemia is rare in individuals without drug-treated diabetes mellitus. In a seemingly well individual, the differential diagnosis of hypoglycemia narrows to 2 major categories: 1) accidental, surreptitious, or intentional hypoglycemia, or 2) endogenous hyperinsulinism (EHH). Insulinomas are the most common cause of EHH. Localization of insulinomas can be challenging, as most tumors are less than 2 cm in size and may be present in any part of the pancreas. In fact, almost 30% of neuroendocrine tumors (NET) cannot be located preoperatively by traditional imaging techniques such as computerized tomography (CT) or magnetic resonance imaging (MRI).

CASE REPORT: This report describes a case of metastatic insulinoma in a patient with a complex medical history. CT with contrast of the abdomen identified 1 lesion located in the pancreas body. Endoscopic ultrasound (EUS) identified an additional 3 to 4 hypoechoic lesions in the pancreatic neck and body. 68-Gallium Dotatate scanning identified 3 distinct lesions within the pancreas and a right posterior rib sclerotic lesion.

CONCLUSIONS: Reliance upon traditional imaging techniques (CT/MRI) for tumor localization would not have identified the multifocal pancreatic lesions and the metastatic bone lesion. Accurate identification of multifocal, metastatic insulinomas requires multiple imaging modalities, including first-line non-invasive imaging (CT or MRI) followed by second-line imaging (EUS or nuclear imaging).

Keywords: Endoscopic Ultrasound-Guided Fine Needle Aspiration, Insulinoma, Magnetic Resonance Imaging, neuroendocrine tumors, Nuclear Medicine, Tomography, X-Ray Computed, Ablation Techniques, Bone Neoplasms, Diagnosis, Differential, diazoxide, Endosonography, Hypoglycemia, Incidental Findings, Pancreatic Neoplasms, Ribs

Add Comment 0 Comments

In Press

Case report  Belgium

Takotsubo Syndrome-Induced Cardiogenic Shock in Lung Transplantation: Importance of Early Diagnosis and ECM...

Am J Case Rep In Press; DOI: 10.12659/AJCR.944942  

Case report  China

Priapism Following Coronary Angiography: A Case Report and Clinical Insights for Diagnosis and Management

Am J Case Rep In Press; DOI: 10.12659/AJCR.943609  

Case report  USA

Anterior Mitral Line Ablation-Induced Complete Heart Block: A Cautionary Case Study

Am J Case Rep In Press; DOI: 10.12659/AJCR.945818  

Case report  South Korea

Dual-Plate Fixation in Treatment of Clavicle Fractures in Dementia Patients: A Case Series

Am J Case Rep In Press; DOI: 10.12659/AJCR.945489  

Most Viewed Current Articles

21 Jun 2024 : Case report  China (mainland) 72,630

Intracranial Parasitic Fetus in a Living Infant: A Case Study with Surgical Intervention and Prognosis Anal...

DOI :10.12659/AJCR.944371

Am J Case Rep 2024; 25:e944371

0:00

07 Mar 2024 : Case report  USA 44,111

Neurocysticercosis Presenting as Migraine in the United States

DOI :10.12659/AJCR.943133

Am J Case Rep 2024; 25:e943133

0:00

10 Jan 2022 : Case report  Germany 32,596

A Report on the First 7 Sequential Patients Treated Within the C-Reactive Protein Apheresis in COVID (CACOV...

DOI :10.12659/AJCR.935263

Am J Case Rep 2022; 23:e935263

23 Feb 2022 : Case report  USA 20,506

Penile Necrosis Associated with Local Intravenous Injection of Cocaine

DOI :10.12659/AJCR.935250

Am J Case Rep 2022; 23:e935250

Your Privacy

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.

American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923