Recurrent Hypoglycemia in Baby with Insulinoma: A Case Report

Ni Putu Sukma Sumantri Prabandari; I Nyoman Wande; Ni Nyoman Mahartini

doi:10.3889/oamjms.2022.9727

Authors

Ni Putu Sukma Sumantri Prabandari Department of Clinical Pathology, Medical Faculty, Udayana University, Sanglah Hospital, Denpasar, Bali, Indonesia
I Nyoman Wande Department of Clinical Pathology, Medical Faculty, Udayana University, Sanglah Hospital, Denpasar, Bali, Indonesia
Ni Nyoman Mahartini Department of Clinical Pathology, Medical Faculty, Udayana University, Sanglah Hospital, Denpasar, Bali, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2022.9727

Keywords:

Insulinoma, Infant, Hypoglycemia, Pancreatic neuroendocrine tumor, Partial pancreatectomy

Abstract

BACKGROUND: Insulinoma is a functional neuroendocrine tumor in the pancreas that can cause hypoglycemia due to endogenic hyperinsulinism. Insulinoma is a rare case with an incidence of 1–4 cases per million people each year. Insulinoma can occur at various ages and mostly occurs in adults with a predominance in women.

CASE REPORT: A baby boy aged 1 month 23 days was referred from Prof. Dr. W. Z. Johannes Hospital with the chief complaint was seizures. The results of the examination of blood glucose levels at Sanglah Hospital were 28 mg/dl. There were some episodes of normal blood glucose level in the patient after having some doses of glucose infusion therapy. However, it was only for a while, the blood glucose level came back low and induced the symptoms of the seizure (neuroglycopenia). The seizures stopped after having anticonvulsant therapy and blood glucose levels within normal limits. These symptoms were consistent with the Whipple triad in insulinoma. The patient has an elevated insulin level (92 IU/ml). Computed tomography scan of the abdomen with contrast showed a mass in the caudal part of the pancreas. The patient underwent a partial pancreatectomy. Histomorphology features showed pancreatic neuroendocrine tumors without metastases. Immunohistochemical results of Ki-67 showed well-differentiated neuroendocrine tumors grade 2.

CONCLUSION: Based on clinical, physical examination, laboratory, and radiology findings, the patient was diagnosed with recurrent hypoglycemia due to insulinoma and improved with partial pancreatectomy.

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