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

0 Comments

SARS-CoV-2/COVID-19

11 January 2022 : Case report  Oman

Myocarditis, Pulmonary Hemorrhage, and Extensive Myositis with Rhabdomyolysis 12 Days After First Dose of P...

Am J Case Rep In Press; DOI: 10.12659/AJCR.934399  

12 January 2022 : Case report  USA

Guillain-Barré Syndrome After Ad26.COV2.S Vaccination

Am J Case Rep In Press; DOI: 10.12659/AJCR.935275  

10 January 2022 : Case report  Philippines

Pulmonary Function and Chest Computed Tomography (CT) Scan Findings After Antifibrotic Treatment for COVID-...

Am J Case Rep In Press; DOI: 10.12659/AJCR.934830  

07 January 2022 : Case report  Saudi Arabia

Extensive Cerebral Venous Sinus Thrombosis (CVST) After the First Dose of Pfizer-BioNTech BNT162b2 mRNA COV...

Am J Case Rep In Press; DOI: 10.12659/AJCR.934744  

In Press

14 Jan 2022 : Case report  Palestinian Territory, Occupied

Successful Treatment for Isolated Bone Marrow Hodgkin Lymphoma in an Human Immunodeficiency Virus (HIV)-Neg...

Am J Case Rep In Press; DOI: 10.12659/AJCR.935045  

13 Jan 2022 : Case report  Japan

Relapsing Infectious Mononucleosis-Like Symptoms Associated with Liver Insufficiency in a Chronic Hepatitis...

Am J Case Rep In Press; DOI: 10.12659/AJCR.934003  

13 Jan 2022 : Case report  Oman

Myocarditis, Pulmonary Hemorrhage, and Extensive Myositis with Rhabdomyolysis 12 Days After First Dose of P...

Am J Case Rep In Press; DOI: 10.12659/AJCR.934399  

12 Jan 2022 : Case report  USA

Pasteurella Endocarditis in a Patient with Rheumatic Mitral Valve Disease

Am J Case Rep In Press; DOI: 10.12659/AJCR.935270  

Most Viewed Current Articles

10 Jan 2022 : Case report  Germany

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

06 Dec 2021 : Case report  Brazil

Lipedema Can Be Treated Non-Surgically: A Report of 5 Cases

DOI :10.12659/AJCR.934406

Am J Case Rep 2021; 22:e934406

24 Jul 2020 : Case report  Canada

Symptoms of Pleurisy as the Initial Presentation of COVID-19

DOI :10.12659/AJCR.925775

Am J Case Rep 2020; 21:e925775

09 Dec 2021 : Case report  USA

Left Ventricular Assist Device Pump Thrombosis in a Patient Treated with Apixaban

DOI :10.12659/AJCR.934787

Am J Case Rep 2021; 22:e934787

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