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Metastatic Insulinoma Following Resection of Nonsecreting Pancreatic Islet Cell Tumor: A Case Report and Review of the Literature.

Koshy AA, Gordon IO, Van Ha TG, Kaplan EL, Philipson LH - J Investig Med High Impact Case Rep (2013)

Bottom Line: Two years later, computed tomography scan of the abdomen showed multiple liver lesions.Laboratory results showed elevated proinsulin, insulin levels, and c-peptide levels during a hypoglycemic episode.Computed tomography scan of the abdomen redemonstrated multiple liver lesions.

View Article: PubMed Central - PubMed

Affiliation: University of Chicago Medical Center, Chicago, IL, USA.

ABSTRACT
A 56-year-old woman presented to our clinic for recurrent hypoglycemia after undergoing resection of an incidentally discovered nonfunctional pancreatic endocrine tumor 6 years ago. She underwent a distal pancreatectomy and splenectomy, after which she developed diabetes and was placed on an insulin pump. Pathology showed a pancreatic endocrine neoplasm with negative islet hormone immunostains. Two years later, computed tomography scan of the abdomen showed multiple liver lesions. Biopsy of a liver lesion showed a well-differentiated neuroendocrine neoplasm, consistent with pancreatic origin. Six years later, she presented to clinic with 1.5 years of recurrent hypoglycemia. Laboratory results showed elevated proinsulin, insulin levels, and c-peptide levels during a hypoglycemic episode. Computed tomography scan of the abdomen redemonstrated multiple liver lesions. Repeated transarterial catheter chemoembolization and microwave thermal ablation controlled hypoglycemia. The unusual features of interest of this case include the transformation of nonfunctioning pancreatic endocrine tumor to a metastatic insulinoma and the occurrence of atrial flutter after octreotide for treatment.

No MeSH data available.


Related in: MedlinePlus

(A) Contrast-enhanced CT of the abdomen/pelvis (date: April 13, 2011) showed a dominant left lobe mass (arrow). Smaller liver lesions were also present (not shown). (B) Octreotide scan (date: April 14, 2011) showed a focus of intense uptake in the right lobe of the liver consistent with neuroendocrine metastasis, and numerous additional smaller foci of increased uptake are noted in the liver consistent with metastatic disease (small arrows)
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fig3-2324709612473274: (A) Contrast-enhanced CT of the abdomen/pelvis (date: April 13, 2011) showed a dominant left lobe mass (arrow). Smaller liver lesions were also present (not shown). (B) Octreotide scan (date: April 14, 2011) showed a focus of intense uptake in the right lobe of the liver consistent with neuroendocrine metastasis, and numerous additional smaller foci of increased uptake are noted in the liver consistent with metastatic disease (small arrows)

Mentions: She continued to have low blood sugars in the 30s to 40s mg/dL range. Her blood glucose in clinic was 53 mg/dL and with symptoms of diaphoresis, tachypnea, and tachycardia (92 bpm). A critical blood sample was drawn. Her blood glucose was 64 mg/dL with a c-peptide of 6.76 pmol/mL (normal range 0.3-2.35). Her insulin level was elevated to 578 uIU/mL with a proinsulin of 4300 pmol/L (normal range 3-20) and glucagon of 53 pg/mL (normal <80). Her serum cortisol at 3:43 pm was 18.2 µg/dL. Her vasoactive intestinal peptide was 28 pg/mL (normal <75) with a chromogranin A of 2040 ng/mL (normal <225), free thyroxine of 0.92 ng/dL (normal range 0.9-1.7), thyroid-stimulating hormone of 2.97 µU/mL (normal range 0.3-4), and HbA1c of 4.9%. She underwent a CT scan of her abdomen and pelvis on April 13, 2011, which showed multiple hepatic metastases, the largest of which increased in size since the previous exam (see Figure 3A).


Metastatic Insulinoma Following Resection of Nonsecreting Pancreatic Islet Cell Tumor: A Case Report and Review of the Literature.

Koshy AA, Gordon IO, Van Ha TG, Kaplan EL, Philipson LH - J Investig Med High Impact Case Rep (2013)

(A) Contrast-enhanced CT of the abdomen/pelvis (date: April 13, 2011) showed a dominant left lobe mass (arrow). Smaller liver lesions were also present (not shown). (B) Octreotide scan (date: April 14, 2011) showed a focus of intense uptake in the right lobe of the liver consistent with neuroendocrine metastasis, and numerous additional smaller foci of increased uptake are noted in the liver consistent with metastatic disease (small arrows)
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4528785&req=5

fig3-2324709612473274: (A) Contrast-enhanced CT of the abdomen/pelvis (date: April 13, 2011) showed a dominant left lobe mass (arrow). Smaller liver lesions were also present (not shown). (B) Octreotide scan (date: April 14, 2011) showed a focus of intense uptake in the right lobe of the liver consistent with neuroendocrine metastasis, and numerous additional smaller foci of increased uptake are noted in the liver consistent with metastatic disease (small arrows)
Mentions: She continued to have low blood sugars in the 30s to 40s mg/dL range. Her blood glucose in clinic was 53 mg/dL and with symptoms of diaphoresis, tachypnea, and tachycardia (92 bpm). A critical blood sample was drawn. Her blood glucose was 64 mg/dL with a c-peptide of 6.76 pmol/mL (normal range 0.3-2.35). Her insulin level was elevated to 578 uIU/mL with a proinsulin of 4300 pmol/L (normal range 3-20) and glucagon of 53 pg/mL (normal <80). Her serum cortisol at 3:43 pm was 18.2 µg/dL. Her vasoactive intestinal peptide was 28 pg/mL (normal <75) with a chromogranin A of 2040 ng/mL (normal <225), free thyroxine of 0.92 ng/dL (normal range 0.9-1.7), thyroid-stimulating hormone of 2.97 µU/mL (normal range 0.3-4), and HbA1c of 4.9%. She underwent a CT scan of her abdomen and pelvis on April 13, 2011, which showed multiple hepatic metastases, the largest of which increased in size since the previous exam (see Figure 3A).

Bottom Line: Two years later, computed tomography scan of the abdomen showed multiple liver lesions.Laboratory results showed elevated proinsulin, insulin levels, and c-peptide levels during a hypoglycemic episode.Computed tomography scan of the abdomen redemonstrated multiple liver lesions.

View Article: PubMed Central - PubMed

Affiliation: University of Chicago Medical Center, Chicago, IL, USA.

ABSTRACT
A 56-year-old woman presented to our clinic for recurrent hypoglycemia after undergoing resection of an incidentally discovered nonfunctional pancreatic endocrine tumor 6 years ago. She underwent a distal pancreatectomy and splenectomy, after which she developed diabetes and was placed on an insulin pump. Pathology showed a pancreatic endocrine neoplasm with negative islet hormone immunostains. Two years later, computed tomography scan of the abdomen showed multiple liver lesions. Biopsy of a liver lesion showed a well-differentiated neuroendocrine neoplasm, consistent with pancreatic origin. Six years later, she presented to clinic with 1.5 years of recurrent hypoglycemia. Laboratory results showed elevated proinsulin, insulin levels, and c-peptide levels during a hypoglycemic episode. Computed tomography scan of the abdomen redemonstrated multiple liver lesions. Repeated transarterial catheter chemoembolization and microwave thermal ablation controlled hypoglycemia. The unusual features of interest of this case include the transformation of nonfunctioning pancreatic endocrine tumor to a metastatic insulinoma and the occurrence of atrial flutter after octreotide for treatment.

No MeSH data available.


Related in: MedlinePlus