Reversible central adrenal insufficiency induced by recurrent insulinoma-related hypoglycemia: a case report and physiological modeling

Insulinoma-related hypoglycemia can mimic various clinical presentations, leading to frequent misdiagnosis and significant treatment delay. We present a unique case report of a 46-year-old female patient with a history of Graves’ disease who developed reversible central adrenal insufficiency (CAI) due to recurrent insulinoma-related hypoglycemia. Despite being initially labeled as “idiopathic” CAI, her diagnosis was eventually revised after persistent questioning of her atypical progression. After insulinoma resection, she completely recovered her hypothalamus–pituitary–adrenal axis function. This paper also proposes an integrative pathophysiological model to elucidate the alterations of the counterregulatory hormone response in endogenous hyperinsulinism.