Abdul Rahman Alshaikh, Mohammad Madaawi, Saeesd Lutf, Soliaman Fageeh.
Non Insulinoma pancreatogenous hypoglycemia.
Pak J Med Sci Jan ;21(4):485-8.

A middle age Saudi male patient presented with attacks of hypoglycemia for almost three years. Insulin and c- peptide levels were high with attacks of hypoglycemia. All investigations to localize the source of the insulin were normal which include CT scan and MRI of the abdomen and celiac angiography. Glucose tolerance test was normal. Selective catheterization of all arteries was done which supply the pancrease and injection calcium chloride was injected in each artery alone, and simultaneous samples from the portal vein were collected. The result revealed high insulin and c- peptide from gastro pancreatic artery which supply the head of the pancrease. The decision was made to resect the head of the pancrease. There was no tumor found on intraoperative examination. The surgery was uneventful and there was no hypoglycemia up to 3 weeks after surgery with normal insulin and c- peptide levels. The pathology of the resected part of the pancrease showed hyperplasia and no insulinoma.

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