Hypoglycemia, Insulinoma

More confusion

Step 1: View clinicals

A 53 year old male nurse presents with drowsiness and confusion for several hours. Prior to becoming drowsy, he complained of palpitations and sweating. He was previously well, with an unremarkable medical history. He does not drink or use recreational drugs. His full blood count and electrolytes are normal, but his capillary blood sugar is 40 mg/dl. Following administration of IV dextrose, he recovers completely.

Step 2: Order all relevant investigations

Sulfonylurea screen

The sulfonylurea screen is negative

Supervised 72-h fast test

The patient becomes symptomatic after 16 hours of fasting. Investigations show: RBS: 39 mg/dl (low) S. Insulin: 16 uU/ml (high) S. C-peptide: 2.9 ng/ml (high) No ketone bodies

Insulin antibodies

No antibodies to insulin or insulin receptors are detected

CT Abdomen (Contrast)

The contrast CT scan of the abdomen shows an enhancing lesion in the pancreatic body which is 1.1cm in diameter. No other abnormalities are noted.

Step 3: Select appropriate management

IV Antibiotics
Frequent meals
Surgical Resection

Score: ★★☆