Mahmud Z Jilani, Huma Habib.
J Surg Pak Jan ;7(1):36-8.

Presented here is a rare case of insulinoma (with no focal detectable lesion) in a 56 year old male. The patient was diagnosed as a case of neuropsychiatric disorder and epilepsy. He remained under treatment of various specialists, hakims and homeopaths as an epileptic, until the diagnosis of insulinoma was made. Blood sugar levels were initially not significantly low. CT scan, MRI scan etc., failed to localize any pancreatic tumor and therefore, selective trans-venous sampling of insulin was done from various sites around the pancreas. These were suggestive of a lesion in the distal third of the pancreas. Per operatively, no tumor could be identified and a sub-total pancreatectomy was done removing about 60-70% of the pancreas including the tail and body. Unfortunately, the hypoglycemic attacks persisted following surgery with associated neuropsychiatric symptoms. Thereafter, the patient was put on diazoxide, which controlled almost all his symptoms by maintaining normal blood sugar levels. Hence, need for any further surgical intervention was avoided. Various behavioral and epileptiform attacks of the patient settled and he is asymptomatic over the last five years of regular outpatient follow-up.

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