Insulinoma misdiagnosed as epilepsy

Ouadii Mouaqit, Ayman Boubouh, Lahcen Ifrine, El Hadj Omar El Malki, Raouf Mohsine, Abdelkader Belkouchi

Surgery Departement A, Ibn Sina University Hospital, Rabat, Morocco..

DOI: 10.4236/ojgas.2012.21006                

Abstract

Insulinoma is a rare disease presenting with episodic neuroglycopenic and/or adrenergic symptoms. We describe the clinical case of a female subject, 44 years old, affected with insulinoma, misdiagnosed for two years as epilepsy, threaten with antiepileptics. Insuli-noma was diagnosed based on fasting blood glucose level of 15 mg/dl, high fasting immunoreactive insu-lin/blood glucose ratio (more than 0.3), and a tumor in the pancreas by abdominal CT. After surgical re-moval of the neoplasm, the blood glucose level and insulin level turned normal. A benign insulinoma was also confirmed by histopathological evaluation. The patient remained seizure-free during the 2-year follow up.

Keywords

Insulinoma; Epilepsy; Convulsions; Hypoglycemia; Surgery

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Ding, Y., Wang, S., Liu, J., Yang, Y., Liu, Z., Li, J., Zhang, B., Chen, Y. and Ding, M. (2010) Neuropsychiat- ric profiles of patients with insulinomas. European Neu- rology, 63, 48-51.
[2]	Crespel, A., Barbaud, A., Andrieu, J.M., Oziole, E., Cou- bes, P. and Gélisse, P. (2009) Insulinoma presenting as pseudo-drug-resistant focal epilepsy. Revue Neurologique, 165, 493-495. doi:10.1016/j.neurol.2008.08.004
[3]	Gnacńska, M., Lewczuk, A., Sworczak, K. (2008) Insu- linoma misdiagnosed and treated as epilepsy. Polski Mer- kuriusz Lekarski, 24, 251-253.
[4]	Wang, S., Hu, H.T., Wen, S.Q., Wang, Z.J., Zhang, B.R. and Ding, M.P. (2008) An insulinoma with clinical and electroencephalographic features resembling complex par- tial seizures. Journal of Zhejiang University Science B, 9, 496-499. doi:10.1631/jzus.B0720011
[5]	Blasetti, A., Di Pietro, L., di Corcia, G., Franzoni, E., Chiarelli, F. and Verrotti, A. (2007) Can insulinoma cause generalised epilepsy? Journal of Pediatric Endocrinology and Metabolism, 20, 837-840. doi:10.1515/JPEM.2007.20.7.837
[6]	Suzuki, K., Miyamoto, M., Miyamoto, T. and Hirata, K. (2007) Insulinoma with ear-ly-morning abnormal behavior. Internal Medicine, 46, 405-408. doi:10.2169/internalmedicine.46.6071
[7]	Alemdar, M., Iseri, P. and Komsuoglu, S.S. (2006) Insu- linoma in differential diagnosis of seizure disorder. Jour- nal of Neuropsychiatry and Clinical Neuroscience, 18, 247-248. doi:10.1176/appi.neuropsych.18.2.247-a
[8]	Striano, P. and Striano, S. (2006) Insulinoma presenting as refractory late-onset epilepsy. Epilepsia, 47, 452. doi:10.1111/j.1528-1167.2006.00444_6.x
[9]	Twardowschy, C.A., Leite, S.A., Outi, T.Y. and Dykyj, M.T. (2005) Insulino-ma presenting as seizure: Case re- port. Arquivos de Neu-ro-Psiquiatria, 63, 685-688. doi:10.1590/S0004-282X2005000400026
[10]	Graves, T.D., Gandhi, S., Smith, S.J., Sisodiya, S.M. and Conway, G.S. (2004) Misdiagnosis of seizures: Insulino- ma presenting as adult-onset seizure disorder. Journal of Neurol Neurosurg Psychiatry, 75, 1091-1092 doi:10.1136/jnnp.2003.029249
[11]	Muscatiello, N., Cuomo, R., Gentile, M., De Francesco, V., Stoppino, V., Contillo, A., Salcuni, A., Natale, C., Pa- nella, C. and Ierardi, E. (2003) En-doscopic ultrasound lo- calization of a solitary insulinoma of pancreatic tail mis- diagnosed as epilepsy: Case report. Abdo-minal Imaging, 28, 859-861. doi:10.1007/s00261-003-0039-5
[12]	Striano, S., Striano, P., Manganelli, F., Boccella, P., Bru- no, R., Santoro, L. and Per-copo, V. (2003) Distal hypo- glycemic neuropathy. An insuli-noma-associated case, mis- diagnosed as temporal lobe epilepsy. Neurophysiologie Clinique, 33, 223-227. doi:10.1016/j.neucli.2003.08.001
[13]	Schwaninger, M., Haehnel, S., Hess, K., et al. (2002) Cerebellar ataxia after re-peated hypoglycemia. European Journal of Neurology, 9, 541-545. doi:10.1046/j.1468-1331.2002.04454.x