Journal of Precision Biosciences
Biopharmaceuticals and medical sciences | Online ISSN 3064-9226
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RESEARCH ARTICLE   (Open Access)
Contents Vol 6 (1)

Co-existence of Diabetes Mellitus and Insulinoma in a 66-Year-Old Caucasian Woman – A Rare Cause of Persistent Hypoglycemia Case study

Yogarajan R1, Jayakumari S2, Sumathi K3 and Mohan Kumar P R*4

+ Author Affiliations

Journal of Precision Biosciences 6 (1) 1-5 https://doi.org/10.25163/biosciences.612183

Submitted: 01 January 2024 Revised: 01 February 2024  Published: 02 February 2024 

Abstract

Background: Diabetes mellitus (DM) is a common metabolic disorder often complicated by hypoglycemia, typically due to insulin excess or use of insulin secretagogues. While hypoglycemia is usually attributed to antidiabetic medications, rare causes like insulinoma, an insulin-secreting pancreatic tumor, must be considered when hypoglycemia persists despite adjustments in therapy. The coexistence of insulinoma and DM is exceedingly rare, with fewer than 40 cases reported globally, presenting significant diagnostic challenges. Methods: We report the case of a 66-year-old woman with type 2 DM treated with insulin, who experienced recurrent hypoglycemic episodes. After discontinuation of insulin therapy, her hypoglycemia persisted, necessitating further evaluation. The patient underwent biochemical testing to confirm endogenous hyperinsulinism and imaging studies for tumor localization. A diagnosis of insulinoma was confirmed through computed tomography (CT) imaging, followed by surgical intervention. Results: Biochemical testing during a documented hypoglycemic episode revealed elevated serum insulin (84.8 μU/mL) and C-peptide levels (8.7 ng/mL), consistent with endogenous hyperinsulinism. Imaging confirmed a pancreatic mass suggestive of an insulinoma. The patient underwent a distal pancreatectomy, and postoperatively, her hypoglycemic episodes ceased. However, she required the resumption of insulin therapy due to persistent hyperglycemia, with improved glycemic control at follow-up. Conclusion: This case highlights the diagnostic complexity of insulinoma in a diabetic patient, emphasizing the importance of considering rare etiologies for persistent hypoglycemia after discontinuing glucose-lowering medications. Early recognition and appropriate intervention are crucial to prevent complications associated with delayed diagnosis. Awareness of the rare coexistence of insulinoma and DM is essential for timely diagnosis and management.

Keywords: Insulinoma, Type 2 Diabetes Mellitus, Hypoglycemia, Endogenous Hyperinsulinism, Diagnostic Challenges

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