Insulinoma Presenting With Postprandial Hypoglycemia in a Pregnant Woman With MEN-1

Author:

Wood Anna J12ORCID,Kasireddy Vidya1,Chitturi Sridhar13,Walsh John P45

Affiliation:

1. Department of Endocrinology, Royal Darwin Hospital , Casuarina, Northern Territory 0810 , Australia

2. Menzies School of Health Research , Charles Darwin University , Casuarina, Northern Territory , Australia

3. School of Medicine, Flinders University, Northern Territory Medical Program , Tiwi, Northern Territory , Australia

4. Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital , Nedlands , Australia

5. Medical School, University of Western Australia , Crawley , Australia

Abstract

AbstractInsulinomas are rare insulin-secreting tumors of pancreatic origin that cause hypoglycemia and can be associated with multiple endocrine neoplasia type 1 (MEN1). While rare, they are the most common cause of hypoglycemia related to endogenous hyperinsulinism. A 28-year-old woman with known MEN1 presented with postprandial hypoglycemia in the second trimester of pregnancy. Prior to her presentation she was known to have several pancreatic neuroendocrine tumors that had been stable on serial imaging, but no history of hypoglycemia. She was managed with dietary intervention during pregnancy and gave birth to a healthy baby at 37 weeks’ gestation. After pregnancy, hypoglycemia initially resolved, but then recurred at 8 months post partum. Magnetic resonance imaging showed several pancreatic neoplasms with the largest lesion measuring 29 mm in the pancreatic tail, unchanged from previous imaging. After localization with a selective arterial calcium stimulation test, the patient underwent successful distal pancreatectomy with resolution of symptoms. This case is unusual in that her initial presentation was during pregnancy, she had predominantly postprandial rather than fasting hypoglycemia, and her symptoms remitted for several months after delivery. Key learning points are to have a low index of suspicion for an insulinoma when there is a history of MEN1 and the need for a pragmatic approach to diagnosis and treatment during pregnancy.

Publisher

The Endocrine Society

Reference10 articles.

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3. Functioning insulinoma—incidence, recurrence, and long-term survival of patients: a 60-year study;Service;Mayo Clin Proc,1991

4. The clinical expression and impact of multiple endocrine neoplasia 1 during pregnancy;Hogg;Clin Endocrinol (Oxf),2020

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