P04 | When hypoglycemia becomes a real challenge for the internist

Background: Insulinoma is a neuroendocrine tumor characterized by overproduction of insulin which causes hypoglycema which can be fatal. The incidence is of 1 case per million/year. Case presentation: A 17-yrs-old girl is found unconscious, unresponsive, with no sphincter release. At the emergency department hypoglycemia (25mg/dl) was found. In history: previous rheumatic disease. Several episodes of hypoglycemia were observed during hospitalization; pharmacological causes were excluded; blood tests showed: increased levels of C-peptide (5.83 ng/ml) and insulin (54.5 IU/mL), instead normal values of GH, IGF1, cortisoluria, cortisol, thyroid, liver and kidney function, autoimmunity was negative (antiGAD, antidecarboxylase of glutamic acid, anti-insulin, antiZnT8, antiIA2, anti tyrosine phosphatase). After starting a therapy with diazzoxide we monitored glycemic values using a glucose sensor and we observed normal glicemia. An abdominal MRI showed no pancreatic lesions but glucagon test after prolonged fasting was positive so we performed a PET scan with 68GA-DOTATOC receptor tracer with up-take at the level of the pancreatic body. Echoendoscopy with biopsy showed histology compatible with isulinoma. Patient underwent surgery. Conclusions: Hypoglycemia is challenge in Internal Medicine. One of the causes of hypoglycemia is insulinoma. Knowing the correct diagnostic procedure can help the clinician make a diagnosis more quickly and save the patient from life-threatening hypoglycemic crises.