Insulinoma: A Rare Neuroendocrine Tumour - Case Report

Introduction: Insulinoma is one of the uncommon neuroendocrine tumours. Most of these are benign although less than 10% of them may be malignant. Resulting hyperinsulinaemia initiates frequent attacks of hypoglycaemia which affect patient’s quality of life and it may be life threatening. Surgery is the mainstay of treatment for this uncommon tumour. Case Report: We reported about a lady with episodic and repetitive symptoms of hypoglycaemia for 2 years, who was diagnosed as a case of pancreatic insulinoma. The localization of tumour was done by endoscopic ultrasound scan preoperatively and bimanual examination during operation. The enucleation of tumour via the open surgical exploration was successfully done. Discussion: Although the working diagnosis of insulinoma can be obtained by thorough history taking, definite diagnosis may be a great challenge for clinician. The gold standard biochemical tests for diagnosis of insulinoma are measurement of plasma glucose, insulin, C-peptide, and proinsulin during a 72-hour fasting. To date, the only chance of cure for insulinoma is surgery and medical treatments are only reserved for the patients who are unfit for surgical operation. Current clinical practice for managing neuroendocrine tumors often depends on the surgeon’s discretion due to the lack of clear guidelines. Conclusion: The meticulous surgical technique with tailored surgical decision making and multimodal perioperative care is crucial for the successful outcome in the management of patient with pancreatic insulinoma.