Insulinoma is one of the most common neuro-endocrine tumors of the pancreas. Some cases with insulinoma present with neuropsychiatric symptoms and are often misdiagnosed as psychosis so patients may remain symptomatic from one week to as long as several decades before diagnosis. We present a case who presented in our hospital with episodic abnormal behavior and seizures 7 years ago. Further investigations proved her to be a case of insulinoma. Nucleation of the tumor was done following which the patient was relieved of symptoms for 3 years after which the symptoms relapsed and admitted with coma and stroke. Her biochemical profile revealed fasting blood glucose of 25 mg/dl. Unfortunately, insulinoma may be so small and diffuse throughout the pancreas that they are not apparent to the surgeon and it is important to realize that blood glucose levels often start to fall within a few months even following successful surgery. Introduction Hypoglycemia is low blood sugar that could cause by pancreatic tumors called insulinomas or islet cell tumors. The incidence is 1–4 per million (1). While these tumors are usually benign, they produce large amounts of insulin, which lowers blood glucose levels. This is the opposite of the diabetes mellitus in which low insulin levels lead to hyperglycemia. Insulinomas present with the neuroglycopenic and sympathoadrenal symptoms induced by hypoglycemia (2). Recurrent confusional states are typical of insulinoma. Other symptoms include visual changes, unusual behavior, palpitations, diaphoresis, and tremulousness (3).Some cases with insulinoma present with neuropsychiatric symptoms and are often misdiagnosed as psychosis (4). In one study, as many as 20% of patients had been misdiagnosed with a psychiatric, seizure, or other neurological disorder before the true diagnosis of insulinoma was made (5). Insulinomas are frequently a recurring problem. Fasting hypoglycemia in the insulinoma patients is usually due to suppression of glucose production and acceleration of glucose utilization, as is widely thought (6).Insulinoma diagnostic tests are: during a monitored 72 hours fasting: low blood glucose, high serum insulin level and high C-peptide level. A serum insulin concentration of ≥6 μU/ml in the presence of glucose concentration of < 45 mg/dl indicates inappropriate secretion of insulin, consistent with insulinoma. CT scan or MRI of the abdomen to look for a pancreatic tumors and Octreotide scan to look for pancreatic tumors (when CT or MRI scan is unrevealing) are another tests. Also when CT and MRI are not successful, pancreatic arteriography or pancreatic venous sampling with calcium stimulation for insulin could be recommended. According to Besim, endoscopic pancreatic ultrasonography has promising results and may replace invasive angiographic studies in the future (7).Treatment recommendations for insulinomas may vary, but insulinomas initially are best treated by surgical exploration and removal if possible. This allows definite diagnosis, and it provides the veterinarian with an opportunity to remove any obvious pancreatic masses. Insulinomas may occur singly or as groups of small tumors. Unfortunately, these tumors may be so small and diffuse throughout the pancreas that they are not apparent to the surgeon.Here we report our practice with a case of insulinoma who presented with neuropsychological disorders and stroke. Case Report In November 2004, a 42-year-old woman presented to our hospital emergency center with loss of consciousness. Her admission laboratory values were significant for a glucose level of 25 mg/dl. After glucose infusion (50 ml of 50%) the level of consciousness became better and she was only lethargic. The patient was subsequently admitted to the hospital for further work up. Six years ago she admitted in our hospital because of recurrent seizure like attacks in the form of convulsive (tonic-clonic seizures) and also non-convulsive confusional states. Because of some oth
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