Case of Insulinoma in a 2-Months-Old Infant

Niluh Putu Wida Pangestika; I Made Arimbawa; I Made Darma Yuda; Ida Bagus Gede Suparyatha; Dyah Kanya Wati; I Nyoman Budi Hartawan; Kadek Deddy Ariyanta; I Made Darmajaya; I Putu Kurniyanta; Luh Putu Iin Indrayani Maker; Pande Putu Yuli Anandasari; I Nyoman Wande

doi:10.3889/oamjms.2022.8430

Authors

Niluh Putu Wida Pangestika Department of Child Health, Medical School, Udayana University,Sanglah Hospital, Denpasar, Bali, Indonesia
I Made Arimbawa Department of Child Health, Medical School, Udayana University,Sanglah Hospital, Denpasar, Bali, Indonesia
I Made Darma Yuda Department of Child Health, Medical School, Udayana University,Sanglah Hospital, Denpasar, Bali, Indonesia
Ida Bagus Gede Suparyatha Department of Child Health, Medical School, Udayana University,Sanglah Hospital, Denpasar, Bali, Indonesia
Dyah Kanya Wati Department of Child Health, Medical School, Udayana University,Sanglah Hospital, Denpasar, Bali, Indonesia
I Nyoman Budi Hartawan Department of Child Health, Medical School, Udayana University,Sanglah Hospital, Denpasar, Bali, Indonesia
Kadek Deddy Ariyanta Department of Child Surgical, Medical School, Udayana University,Sanglah Hospital, Denpasar, Bali, Indonesia
I Made Darmajaya Department of Child Surgical, Medical School, Udayana University,Sanglah Hospital, Denpasar, Bali, Indonesia
I Putu Kurniyanta Department of Anesthesiology and Intensive Care, Medical School, Udayana University,Sanglah Hospital, Denpasar, Bali, Indonesia
Luh Putu Iin Indrayani Maker Department of Pathology-Anatomy, Medical School, Udayana University,Sanglah Hospital, Denpasar, Bali, Indonesia
Pande Putu Yuli Anandasari Department of Radiology, Medical School, Udayana University,Sanglah Hospital, Denpasar, Bali, Indonesia
I Nyoman Wande Department of Pathology-Clinic, Medical School, Udayana University,Sanglah Hospital, Denpasar, Bali, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2022.8430

Keywords:

Congenital hyperinsulinism, Hypoglycemia, Insulinoma

Abstract

INTRODUCTION: Insulinoma is congenital hyperinsulinism of infancy (CHI). It is a type of functional neuroendocrine tumor (NET) in the pancreas that manifests with persistent hypoglycemia caused by inappropriately high secretion of insulin (hyperinsulinemia). Comprehensive and multidisciplinary management is required for a better outcome.

CASE PRESENTATION: A 2-months-old girl came to the Emergency unit Sanglah Hospital, with a chief complaint of seizure. The patient had a low blood glucose level, high fasting insulin, high LDH, computed tomography of the abdomen result showed isodense heterogeneous lesions border in the cauda pancreas with size 1.32 × 1.24 × 1.35 cm. The anatomy-pathological result showed pancreatic neuroendocrine tumor WHO Grade II, functional, consistent, and clinically to insulinoma on the tail of the pancreas. The patient was treated with hydrocortisone, nifedipine, and octreotide. The patient underwent laparotomy partial pancreatectomy. In post-surgery condition, she had good drink tolerance, no episode of recurrent seizure, and blood glucose was controlled.

CONCLUSION: Insulinoma is a rare disease. The diagnosis was challenging. This case report presents the diagnostic work-up and management of a patient with a persistent hypoglycemia condition that was diagnosed as insulinoma.

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