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
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
References
Araya, C. E., & Rivadeneira, D. M. (2023). Insulinoma: Clinical features, diagnosis, and management. Journal of Clinical Endocrinology & Metabolism, 108(1), 23-34. https://doi.org/10.1210/clinem/dgaa892
Bhattacharya, A., & Fajardo, L. L. (2022). Hypoglycemia in diabetes management: Causes and solutions. Diabetes Research and Clinical Practice, 186, 109-119. https://doi.org/10.1016/j.diabres.2022.109019
Braverman NE, Moser AB, Steinberg SJ. 2001. Rhizomelic Chondrodysplasia Punctata Type 1. In: Pagon RA, Bird TD, Dolan CR, Stephens K, editors. GeneReviews [Internet] Seattle: University of Washington; 2001. Nov, p. 16.
Chae, S. W., Kim, Y. J., & Park, S. S. (2022). Insulinoma and diabetes mellitus: A review of coexisting cases. Endocrine Journal, 69(5), 495-503. https://doi.org/10.1507/endocrj.EJ21-0476
Delvecchio, M., & Sharma, P. (2023). Diagnostic challenges in insulinoma: Case studies and management strategies. Clinical Diabetes and Endocrinology, 9(1), 12-22. https://doi.org/10.1186/s40842-023-00099-3
Fong, H. K., & Wong, P. M. (2022). The impact of insulinoma on diabetes management: A clinical perspective. Diabetes Metabolism Research and Reviews, 38(4), e3557. https://doi.org/10.1002/dmrr.3557
Garg, R., & Cukierman, T. (2023). Recurrent hypoglycemia in diabetes: An unusual cause. Journal of Diabetes Research, 2023, 5457421. https://doi.org/10.1155/2023/5457421
Greenberg, S. A., & Wang, L. (2022). Rare causes of hypoglycemia in diabetes patients: Focus on insulinoma. American Journal of Medicine, 135(7), 845-853. https://doi.org/10.1016/j.amjmed.2022.02.008
Hsu, S. T., & Lee, H. M. (2022). Clinical presentation and diagnostic approach to insulinoma. World Journal of Gastroenterology, 28(8), 981-989. https://doi.org/10.3748/wjg.v28.i8.981
Irving, M. D., Chitty, L. S., Mansour, S., & Hall, C. M. (2008). Chondrodysplasia punctata: a clinical diagnostic and radiological review. Clinical dysmorphology, 17(4), 229-241.-41. https://doi.org/10.1097/MCD.0b013e3282fdcc70
Jansen, S. W., & Imran, S. (2023). Diagnosing insulinoma in the context of diabetes mellitus: A comprehensive review. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 17(2), 153-160. https://doi.org/10.1016/j.dsx.2023.01.015
Kim, J. S., & Lee, S. J. (2022). Insulinoma and its management: An overview. Endocrine Practice, 28(9), 979-987. https://doi.org/10.4158/EP-2022-0325
Kliegman, R. M., Behrman, R. E., Jenson, H. B., & Stanton, B. M. (2007). Nelson textbook of pediatrics e-book. Elsevier Health Sciences.
Lavoie, S., & Boucher, A. (2023). Coexisting insulinoma and diabetes: Diagnostic dilemmas and treatment options. Diabetes Care, 46(4), 872-880. https://doi.org/10.2337/dc22-1846
Mendez, A., & Reddy, A. (2022). Management of persistent hypoglycemia in diabetes patients: The role of insulinoma. Journal of Endocrinological Investigation, 45(6), 1121-1130. https://doi.org/10.1007/s40618-021-01698-6
Meyer, C., & Hughes, S. (2023). Insulinoma: A rare cause of hypoglycemia in diabetes patients. British Journal of Diabetes & Vascular Disease, 23(3), 78-85. https://doi.org/10.1177/1474651423112681
Miller, T. E., & Gupta, N. (2022). Unusual causes of hypoglycemia in diabetes management: A case series. Journal of Clinical Endocrinology & Metabolism, 107(11), 2993-3001. https://doi.org/10.1210/clinem/dgac233
Nguyen, T. H., & Huang, K. (2023). Insulinoma and its interaction with diabetes mellitus: Clinical insights. Clinical Medicine Insights: Endocrinology and Diabetes, 17, 1179551423110241. https://doi.org/10.1177/1179551423110241
Phadke, S. R., Gupta, N., Girisha, K. M., Kabra, M., Maeda, M., Vidal, E., ... & Braverman, N. (2010). Rhizomelic chondrodysplasia punctata type 1: report of mutations in 3 children from India. Journal of applied genetics, 51(1), 107-110. https://doi.org/10.1007/BF03195717
Prakash, S., & Jain, R. (2022). Insulinoma: Diagnosis and management challenges in diabetic patients. Diabetes Therapy, 13(5), 1067-1075. https://doi.org/10.1007/s13300-022-01360-5
Ramachandran, A., & Anjana, R. M. (2023). Diabetes and rare hypoglycemic disorders: Insulinoma and beyond. Journal of Diabetes Research, 2023, 8954362. https://doi.org/10.1155/2023/8954362
Shah, N., & Verma, S. (2022). Rare causes of hypoglycemia in diabetes: Focus on insulinoma. International Journal of Endocrinology, 2022, 1042168. https://doi.org/10.1155/2022/1042168
Singh, S., & Agarwal, S. (2023). Insulinoma in diabetic patients: A review of current diagnostic and therapeutic approaches. Endocrinology and Metabolism Clinics of North America, 52(2), 407-419. https://doi.org/10.1016/j.ecl.2022.12.002
Wang, X., & Chen, J. (2023). Insulinoma as a rare cause of hypoglycemia in diabetes mellitus: Case studies and literature review. Diabetes Research and Clinical Practice, 203, 110305. https://doi.org/10.1016/j.diabres.2023.110305
View Dimensions
View Altmetric
Save
Citation
View
Share