Blog dedicated to the continuous education in Gynecology and Endocrinology

 

<- Back to home

INSULINOMA IN A THIRD TRIMESTER PREGNANT WOMAN COMBINED WITH PRE-ECLAMPSIA: A CASE REPORT AND REVIEW OF THE DIAGNOSTIC STRATEGIES

Erik Christiansen, and Henrik Vestergaard

Insulinomas are rare neuroendocrine tumors with an incidence of 4 insulinomas per one million person years, being even rarer during pregnancy. During pregnancy most cases are recognized or become symptomatic during the first trimester.
A 29 year old woman, primagravida, was hospitalized in 38th gestational week due to slurred speech, weakness and slow reaction patterns. EEG and CT scan of the brain and blood samples were normal. The blood pressure was 170-145/110-95, albuminuria was moderate and there was moderate oedema of the ankles. Labor started spontaneously the 3rd day, 62 hours after of hospitalization, and the patient gave birth to a healthy girl with no neonatal problems. Fourteen hours after delivery, she became comatose and developed universal clonic seizures. At the same time plasma glucose was < 1.1 mmol/l and the patient responded immediately to intravenously glucose.  The patient was managed with frequent small meals and continuously intravenous glucose. Postpartum testing was consistent with insulinoma and diazoxide treatment was initiated. Endoscopic ultrasound with biopsy showed an insulinoma in the head of the pancreas. During surgical exploration, 4 separate insulinomas were removed from the head of the pancreas. The hypoglycemic episodes resolved and the glucose levels normalized.
Following biochemical diagnosis of insulinoma, the diagnostic imaging procedures encounter endoscopic ultrasonography, NMR and digital subtraction angiography. Of isotopic procedures, somatostatin receptor scintigraphy (Octreoscan) and newer receptor binding ligands can be used in non-pregnant women. Intraoperative ultrasonography seems mandatory.
The present case demonstrates that seizure disorders in non-diabetic pregnant women may be caused by hyperinsulinemia induced hypoglycemia due to insulinoma.

Post to Twitter Post to Facebook

< Back to home page

© International Society of Gynecological Endocrinology - Privacy Policy