We report the case of sporadic
insulinoma in an exceptionally very young 10-year-old boy who presented with a 1-month history of episodic tremulousness, diaphoresis, increased hunger,
confusion and
fainting. Initial laboratory investigations showed low
blood glucose (64 mg/dL) and high blood
insulin (6 μU/mL) levels. Patient was admitted in view of frequent
hypoglycemic symptoms and possible pancreatic
insulinoma. A 48-hour mentored fasting test was done and ceased within 3 hours due to occurrence of
hypoglycemic symptoms. During the episode, blood was drawn and results showed low
blood glucose level and high
insulin, pro-
insulin and
C-peptide levels. The
hypoglycemic symptoms were relieved greatly by
glucose administration and Whipple's triad for
insulinoma was met. An abdominal contrast-enhanced computed tomography scan showed
a 10 x 12 x 17 mm, small, well-demarcated, heterogeneously enhancing lesion within the body of pancreas without dilatation of pancreatic duct. No evidence of
lymphadenopathy or distant
metastasis was identified. Patient underwent enucleation of pancreatic
tumor. Histopathological and immunohistochemical examination of the pancreatic mass confirmed
neuroendocrine tumor (
insulinoma). Patient had an uneventful recovery. A post-operative 6-month follow-up showed resolution of
hypoglycemic symptoms, normalized
blood glucose,
insulin, pro-
insulin and
C-peptide levels, and no evidence of recurrence.
CONCLUSION: Although rare, sporadic
insulinoma should be considered in the differential diagnosis of any young individual presenting with frequent
hypoglycemic symptoms (neuroglycopenic and/or autonomic nervous system symptoms). Furthermore, a literature review on
insulinoma is presented.