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A Case of Proinsulin-Secreting Malignant Insulinoma in an Elderly Patient with Cerebral Infarction

Author(s): Dr. Atsuhito Tone

Journal: Journal of Diabetes & Metabolism
ISSN 2155-6156

Volume: 1;
Issue: 3;
Date: 2010;
Original page

Keywords: Malignant insulinoma | Hypoglycemia | Taminato index | Proinsulin

The diagnosis of insulinoma is sometimes challenging and the symptoms of hypoglycemia may be overlooked in elderly patients with cerebrovascular diseases and higher cerebral dysfunction. Recently, there have been an increasing number of case reports of insulinoma secreting proinsulin without hyperinsulinemia. We report a case of proinsulinsecreting malignant insulinoma in a 72-year-old man with aphasia due to cerebral infarction. He manifested no apparent symptoms, although he was incidentally found to have recurrent hypoglycemia by plasma glucose measurements. The Fajans, Grunt and Turner indexes were all within normal range and the arterial stimulation and venous sampling (ASVS) test revealed no increase in insulin concentration. However, proinsulin concentration was markedly elevated (2470 pmol/l) and well-differentiated endocrine adenocarcinoma, malignant insulinoma, with 2 cm in size in the tail of the pancreas was surgically removed.The diagnosis of hypoglycemia requires careful attention especially in elderly persons and/or patients with cerebrovascular diseases. Measurement of proinsulin is recommended in the diagnosis of insulinoma without hyperinsulinemia.
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