Insulinoma presenting with post-prandial hypoglycaemia following fundoplication
Insulinomas are rare neuroendocrine tumours that classically present with fasting hypoglycaemia. This case report discusses an uncommon and challenging case of insulinoma soon after upper gastrointestinal surgery. A 63-year-old man presented with 6 months of post-prandial hypoglycaemia beginning aft...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Bioscientifica
2018-01-01
|
| Series: | Endocrinology, Diabetes & Metabolism Case Reports |
| Online Access: | https://www.edmcasereports.com/articles/endocrinology-diabetes-and-metabolism-case-reports/10.1530/EDM-17-0131 |
| _version_ | 1811301938843615232 |
|---|---|
| author | Sarah Y Qian Matthew J L Hare Alan Pham Duncan J Topliss |
| author_facet | Sarah Y Qian Matthew J L Hare Alan Pham Duncan J Topliss |
| author_sort | Sarah Y Qian |
| collection | DOAJ |
| description | Insulinomas are rare neuroendocrine tumours that classically present with fasting hypoglycaemia. This case report discusses an uncommon and challenging case of insulinoma soon after upper gastrointestinal surgery. A 63-year-old man presented with 6 months of post-prandial hypoglycaemia beginning after a laparoscopic revision of Toupet fundoplication. Hyperinsulinaemic hypoglycaemia was confirmed during a spontaneous episode and in a mixed-meal test. Localisation studies including magnetic resonance imaging (MRI), endoscopic ultrasound (EUS) and gallium dotatate positron emission tomography (68Ga Dotatate PET) were consistent with a small insulinoma in the mid-body of the pancreas. The lesion was excised and histopathology was confirmed a localised well-differentiated neuroendocrine pancreatic neoplasm. There have been no significant episodes of hypoglycaemia since. This case highlights several key points. Insulinoma should be sought in proven post-prandial hyperinsulinaemic hypoglycaemia – even in the absence of fasting hypoglycaemia. The use of nuclear imaging targeting somatostatin and GLP1 receptors has improved accuracy of localisation. Despite these advances, accurate surgical resection can remain challenging. |
| first_indexed | 2024-04-13T07:18:58Z |
| format | Article |
| id | doaj.art-6d911f2dcc0245269847d0796c2abd88 |
| institution | Directory Open Access Journal |
| issn | 2052-0573 2052-0573 |
| language | English |
| last_indexed | 2024-04-13T07:18:58Z |
| publishDate | 2018-01-01 |
| publisher | Bioscientifica |
| record_format | Article |
| series | Endocrinology, Diabetes & Metabolism Case Reports |
| spelling | doaj.art-6d911f2dcc0245269847d0796c2abd882022-12-22T02:56:41ZengBioscientificaEndocrinology, Diabetes & Metabolism Case Reports2052-05732052-05732018-01-01111610.1530/EDM-17-0131Insulinoma presenting with post-prandial hypoglycaemia following fundoplicationSarah Y Qian0Matthew J L Hare1Alan Pham2Duncan J Topliss3Departments of Endocrinology and Diabetes, The Alfred Hospital, Melbourne, AustraliaDepartments of Endocrinology and Diabetes, The Alfred Hospital, Melbourne, AustraliaAnatomical Pathology, The Alfred Hospital, Melbourne, AustraliaDepartments of Endocrinology and Diabetes, The Alfred Hospital, Melbourne, Australia; Department of Medicine, Monash University, Melbourne, AustraliaInsulinomas are rare neuroendocrine tumours that classically present with fasting hypoglycaemia. This case report discusses an uncommon and challenging case of insulinoma soon after upper gastrointestinal surgery. A 63-year-old man presented with 6 months of post-prandial hypoglycaemia beginning after a laparoscopic revision of Toupet fundoplication. Hyperinsulinaemic hypoglycaemia was confirmed during a spontaneous episode and in a mixed-meal test. Localisation studies including magnetic resonance imaging (MRI), endoscopic ultrasound (EUS) and gallium dotatate positron emission tomography (68Ga Dotatate PET) were consistent with a small insulinoma in the mid-body of the pancreas. The lesion was excised and histopathology was confirmed a localised well-differentiated neuroendocrine pancreatic neoplasm. There have been no significant episodes of hypoglycaemia since. This case highlights several key points. Insulinoma should be sought in proven post-prandial hyperinsulinaemic hypoglycaemia – even in the absence of fasting hypoglycaemia. The use of nuclear imaging targeting somatostatin and GLP1 receptors has improved accuracy of localisation. Despite these advances, accurate surgical resection can remain challenging.https://www.edmcasereports.com/articles/endocrinology-diabetes-and-metabolism-case-reports/10.1530/EDM-17-0131 |
| spellingShingle | Sarah Y Qian Matthew J L Hare Alan Pham Duncan J Topliss Insulinoma presenting with post-prandial hypoglycaemia following fundoplication Endocrinology, Diabetes & Metabolism Case Reports |
| title | Insulinoma presenting with post-prandial hypoglycaemia following fundoplication |
| title_full | Insulinoma presenting with post-prandial hypoglycaemia following fundoplication |
| title_fullStr | Insulinoma presenting with post-prandial hypoglycaemia following fundoplication |
| title_full_unstemmed | Insulinoma presenting with post-prandial hypoglycaemia following fundoplication |
| title_short | Insulinoma presenting with post-prandial hypoglycaemia following fundoplication |
| title_sort | insulinoma presenting with post prandial hypoglycaemia following fundoplication |
| url | https://www.edmcasereports.com/articles/endocrinology-diabetes-and-metabolism-case-reports/10.1530/EDM-17-0131 |
| work_keys_str_mv | AT sarahyqian insulinomapresentingwithpostprandialhypoglycaemiafollowingfundoplication AT matthewjlhare insulinomapresentingwithpostprandialhypoglycaemiafollowingfundoplication AT alanpham insulinomapresentingwithpostprandialhypoglycaemiafollowingfundoplication AT duncanjtopliss insulinomapresentingwithpostprandialhypoglycaemiafollowingfundoplication |