A CASE REPORT ON GIANT INSULINOMA

Abstract

INTRODUCTION
Insulinomas are rare pancreatic islet cell tumors with an incidence of 1 case per 250,000 person-years. The clinical manifestation of an insulimona is fasting hypoglycemia with neuroglycopenic symptoms that may or may not be preceeded by sympathoadrenal symptoms. Tumors are usually very small, with 80% being less than 2 cm in diameter. Giant Insulinomas (>9 cm in diameter) are rare.

CASE
A 56-year-old, female without diabetes came in for repeated episodes of hypoglycemia. Biochemical workup showed an elevated serum insulin of 34.57 (4.50- 20.0 uIU/ml) and C-peptide at 12.93 (1.37-11.8 ng/ml) during a supervised fast (RBS 55 mg/dl). Computed Tomography of the whole abdomen with contrast noted a large (12 cm) pancreatic tail mass. Distal pancreatectomy with en bloc splenectomy was done and histopathology revealed a well differentiated neuroendocrine tumor. She remained euglycemic postoperatively.

CONCLUSION
Insulinoma is a rare neuroendocrine tumor, usually benign, but can be life threatening and cause hypoglycemic accidents. Surgical resection remains the treatment of choice with a highly favorable outcome even among giant insulinomas. Medical options are reserved for unresectable or metastatic tumors. Long term follow-up is important to detect recurrence.