Hypoglycemic Syndrome in a Patient with Proinsulin-Only Secreting Pancreatic Adenoma (Proinsulinoma)
We describe an unusual case of hypoglycemic syndrome in a 69-year old woman with a proinsulin-only secreting pancreatic endocrine adenoma. The clinical history was highly suggestive of an organic hypoglycemia, with normal or relatively low insulin concentrations and elevated proinsulin levels. Magne...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2011-01-01
|
| Series: | Case Reports in Medicine |
| Online Access: | http://dx.doi.org/10.1155/2011/930904 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832545762326609920 |
|---|---|
| author | Gian Paolo Fadini Alberto Maran Anna Valerio Francesco Meduri Mariarosa Pelizzo Diego Miotto Cristiano Lanza Giuseppe Altavilla Angelo Avogaro |
| author_facet | Gian Paolo Fadini Alberto Maran Anna Valerio Francesco Meduri Mariarosa Pelizzo Diego Miotto Cristiano Lanza Giuseppe Altavilla Angelo Avogaro |
| author_sort | Gian Paolo Fadini |
| collection | DOAJ |
| description | We describe an unusual case of hypoglycemic syndrome in a 69-year old woman with a proinsulin-only secreting pancreatic endocrine adenoma. The clinical history was highly suggestive of an organic hypoglycemia, with normal or relatively low insulin concentrations and elevated proinsulin levels. Magnetic resonance and computed tomography of the abdomen showed a 1 cm pancreatic nodule and multiple accessory spleens. The diagnosis was confirmed by selective angiography, showing location and vascularization of the nodule, despite no response to intra-arterial calcium. After resection, the hypoglycemic syndrome resolved. The surgical specimen was comprised of a neuroendocrine adenomatous tissue with high proinsulin immunoreactivity. Study of this unusual case of proinsulinoma underlines (i) the need to assay proinsulin in patients with hypoglycemia and normal immunoreactive insulin, (ii) the differential diagnosis in the presence of accessory spleens, (iii) the unresponsiveness to intra-arterial calcium stimulation, and (iv) the extensive evaluation needed to reach a final diagnosis. |
| format | Article |
| id | doaj-art-1b6176aca4634fd3ae41073fef4d2e24 |
| institution | Kabale University |
| issn | 1687-9627 1687-9635 |
| language | English |
| publishDate | 2011-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Medicine |
| spelling | doaj-art-1b6176aca4634fd3ae41073fef4d2e242025-02-03T07:24:42ZengWileyCase Reports in Medicine1687-96271687-96352011-01-01201110.1155/2011/930904930904Hypoglycemic Syndrome in a Patient with Proinsulin-Only Secreting Pancreatic Adenoma (Proinsulinoma)Gian Paolo Fadini0Alberto Maran1Anna Valerio2Francesco Meduri3Mariarosa Pelizzo4Diego Miotto5Cristiano Lanza6Giuseppe Altavilla7Angelo Avogaro8Department of Clinical and Experimental Medicine, Metabolic Division, Medical School, University of Padova, 35100 Padova, ItalyDepartment of Clinical and Experimental Medicine, Metabolic Division, Medical School, University of Padova, 35100 Padova, ItalyDepartment of Clinical and Experimental Medicine, Metabolic Division, Medical School, University of Padova, 35100 Padova, ItalyDepartment of Medical and Surgical Sciences, Medical School, University of Padova, 35100 Padova, ItalyDepartment of Medical and Surgical Sciences, Medical School, University of Padova, 35100 Padova, ItalyDepartment of Medical Diagnostic Sciences and Special Therapies, Medical School, University of Padova, 35100 Padova, ItalyDepartment of Medical Diagnostic Sciences and Special Therapies, Medical School, University of Padova, 35100 Padova, ItalyDepartment of Medical Diagnostic Sciences and Special Therapies, Medical School, University of Padova, 35100 Padova, ItalyDepartment of Clinical and Experimental Medicine, Metabolic Division, Medical School, University of Padova, 35100 Padova, ItalyWe describe an unusual case of hypoglycemic syndrome in a 69-year old woman with a proinsulin-only secreting pancreatic endocrine adenoma. The clinical history was highly suggestive of an organic hypoglycemia, with normal or relatively low insulin concentrations and elevated proinsulin levels. Magnetic resonance and computed tomography of the abdomen showed a 1 cm pancreatic nodule and multiple accessory spleens. The diagnosis was confirmed by selective angiography, showing location and vascularization of the nodule, despite no response to intra-arterial calcium. After resection, the hypoglycemic syndrome resolved. The surgical specimen was comprised of a neuroendocrine adenomatous tissue with high proinsulin immunoreactivity. Study of this unusual case of proinsulinoma underlines (i) the need to assay proinsulin in patients with hypoglycemia and normal immunoreactive insulin, (ii) the differential diagnosis in the presence of accessory spleens, (iii) the unresponsiveness to intra-arterial calcium stimulation, and (iv) the extensive evaluation needed to reach a final diagnosis.http://dx.doi.org/10.1155/2011/930904 |
| spellingShingle | Gian Paolo Fadini Alberto Maran Anna Valerio Francesco Meduri Mariarosa Pelizzo Diego Miotto Cristiano Lanza Giuseppe Altavilla Angelo Avogaro Hypoglycemic Syndrome in a Patient with Proinsulin-Only Secreting Pancreatic Adenoma (Proinsulinoma) Case Reports in Medicine |
| title | Hypoglycemic Syndrome in a Patient with Proinsulin-Only Secreting Pancreatic Adenoma (Proinsulinoma) |
| title_full | Hypoglycemic Syndrome in a Patient with Proinsulin-Only Secreting Pancreatic Adenoma (Proinsulinoma) |
| title_fullStr | Hypoglycemic Syndrome in a Patient with Proinsulin-Only Secreting Pancreatic Adenoma (Proinsulinoma) |
| title_full_unstemmed | Hypoglycemic Syndrome in a Patient with Proinsulin-Only Secreting Pancreatic Adenoma (Proinsulinoma) |
| title_short | Hypoglycemic Syndrome in a Patient with Proinsulin-Only Secreting Pancreatic Adenoma (Proinsulinoma) |
| title_sort | hypoglycemic syndrome in a patient with proinsulin only secreting pancreatic adenoma proinsulinoma |
| url | http://dx.doi.org/10.1155/2011/930904 |
| work_keys_str_mv | AT gianpaolofadini hypoglycemicsyndromeinapatientwithproinsulinonlysecretingpancreaticadenomaproinsulinoma AT albertomaran hypoglycemicsyndromeinapatientwithproinsulinonlysecretingpancreaticadenomaproinsulinoma AT annavalerio hypoglycemicsyndromeinapatientwithproinsulinonlysecretingpancreaticadenomaproinsulinoma AT francescomeduri hypoglycemicsyndromeinapatientwithproinsulinonlysecretingpancreaticadenomaproinsulinoma AT mariarosapelizzo hypoglycemicsyndromeinapatientwithproinsulinonlysecretingpancreaticadenomaproinsulinoma AT diegomiotto hypoglycemicsyndromeinapatientwithproinsulinonlysecretingpancreaticadenomaproinsulinoma AT cristianolanza hypoglycemicsyndromeinapatientwithproinsulinonlysecretingpancreaticadenomaproinsulinoma AT giuseppealtavilla hypoglycemicsyndromeinapatientwithproinsulinonlysecretingpancreaticadenomaproinsulinoma AT angeloavogaro hypoglycemicsyndromeinapatientwithproinsulinonlysecretingpancreaticadenomaproinsulinoma |