Sudden ‘cure’ of type two diabetes due to pancreatic insulinoma: A case report

Nastos,Constantinos; Giannoulopoulos,Dimitrios; Dellaportas,Dionysios; Mizamtsidi,Maria; Dafnios,Nikolaos; Klonaris,Nikolaos; Kalogeris,Nikolaos; Vryonidou,Andromachi

doi:10.3892/mco.2019.1957

Sudden ‘cure’ of type two diabetes due to pancreatic insulinoma: A case report

Authors:
- Constantinos Nastos
- Dimitrios Giannoulopoulos
- Dionysios Dellaportas
- Maria Mizamtsidi
- Nikolaos Dafnios
- Nikolaos Klonaris
- Nikolaos Kalogeris
- Andromachi Vryonidou
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Affiliations: Second Department of Surgery, Endocrine Surgery Unit, National and Kapodistrian University of Athens, School of Medicine, Aretaieion University Hospital, 11528 Athens, Greece, Department of Endocrinology and Diabetes, Hellenic Red Cross Hospital, 11526 Athens, Greece
Published online on: December 3, 2019 https://doi.org/10.3892/mco.2019.1957
Pages: 174-178

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Abstract

Insulinomas are rare tumors of the islet cells of the pancreas and are the most common cause of endogenous hyperinsulinism. Although they usually present with symptoms of hypoglycemia, sometimes they can have vague symptoms. We present the case of a 62‑year‑old diabetic female who was diagnosed with a large insulinoma after being investigated for the ‘cure’ of her diabetes. We also review the literature regarding insulinomas in patients with diabetic. A 62‑year‑old, obese woman with type 2 diabetes mellitus was initially investigated for an unexplained normalization of her blood glucose levels after the cessation of antidiabetic medication due to an episode of severe hypoglycemia. She remained without antidiabetics for three months maintaining normoglycemia, and thereafter, she started experiencing frequent but less severe hypoglycemic episodes. She did not change her diet habits or level of activity and did not lose any weight. The patient underwent further investigation with a supervised 72 h fasting test, which resulted in the biochemical diagnosis of endogenous hyperinsulinism. Imaging studies revealed the presence of a large insulinoma in the head of the pancreas. Finally, the patient underwent a pylorus preserving Whipple procedure, which reversed the aforementioned ‘normalization’ of glucose levels and the underlying diabetes mellitus reappeared. Insulinomas are rare tumors causing hypoglycemia. Even more rarely are found in diabetic patients, making the diagnosis more challenging and probably delayed, as the symptoms are masked by the presence of diabetes, thereby leading to a more advanced disease diagnosis.

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