Khalil Ur Rehman.
Insulinoma.
Pak Armed Forces Med J Jan ;52(1):110-3.

A 23 years old lady had a 3 years history of episodes of feeling of nervousness, fear, anger, giddiness, excessive weakness, occasional palpitation and sweating. Her parents noted that often early in the morning, it was difficult to arouse her and they used to give her some sweet as a house hold measure to combat weakness, which used to produce dramatic arousal response. She had received many anxiolytics, antidepressants and antiepileptics by various doctors. On questioning her she told that her episodes of nervousness used to occur often at noon or late afternoon in the college. As she was found unconscious on the bed quite often, and because of lack of concentration in the classroom, she discontinued her studies. She also disclosed that now she feels relatively better with relief of complaints by taking extra food at late afternoon and before going to bed. She also had a weight gain of approximately 15 kg and complained of some menstrual irregularity. There was no family history of diabetes or hypertension. On examination she was normal looking obese young lady with normal vital signs. Her systemic examinations were also normal. Her fasting blood sugar was advised considering provisional diagnosis of insulinoma and it was 28 mg/dl, which ftirther strengthened the suspicion. Serum calcium was 2.4 mmol/L, sodium 142 mmol/L potassium 3.4 mmol/L. Her blood sample for simultaneous measurement of fasting sugar (12 hours fast) and plasma insulin were sent to Lab. Insulin/glucose ratio of more than 0.4 and often l or above 1 is diagnostic of insulinoma. Tumor CAT scan and splenic and mesenteric angiogram were normal. Patient used to have episodes of hypoglycemia, which were dealt with intravenous dextrose.

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