Insulinoma: Metastatic Recurrence 38 Years Following Initial Diagnosis in Pregnancy

Christopher A Preston; Nirupa Sachithanandan; Ie-Wen Sim; Jon van Heerden; Stephen Farrell

doi:10.1210/jcemcr/luad168

Insulinoma: Metastatic Recurrence 38 Years Following Initial Diagnosis in Pregnancy

JCEM Case Rep. 2024 Jan 8;2(2):luad168. doi: 10.1210/jcemcr/luad168. eCollection 2024 Feb.

Authors

Christopher A Preston^{1

2}, Nirupa Sachithanandan^{1

3}, Ie-Wen Sim^{1

2

3

4

5}, Jon van Heerden^{6

7

8}, Stephen Farrell^{9

10}

Affiliations

¹ Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria 3065, Australia.
² Department of Endocrinology & Diabetes, Western Health, Melbourne, Victoria 3021, Australia.
³ Department of Medicine, The University of Melbourne, Fitzroy, Victoria 3065, Australia.
⁴ Department of Endocrinology & Diabetes, Monash Health and Eastern Health, Melbourne, Victoria 3168, Australia.
⁵ Department of Medicine, Monash University, Clayton, Victoria 3168, Australia.
⁶ Department of Surgery, Mayo Medical School, Rochester, MN 55905, USA.
⁷ Department of Surgery, Mayo Medical School, Mayo Clinic, Rochester, MN 55905, USA.
⁸ Department of Surgery, Medical University of South Carolina, Charleston 29425, USA.
⁹ Department of Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria 3065, Australia.
¹⁰ Department of Surgery, Austin Health, Heidelberg, Victoria 3084, Australia.

Abstract

A case of recurrent insulinoma spanning 4 decades is described. Following a delayed diagnosis, hyperinsulinemic hypoglycemia was confirmed in a 24-year-old woman during early pregnancy. Initial surgery, culminating in subtotal pancreatectomy, was noncurative. A 1-cm insulinoma was subsequently resected from the head of the pancreas postpartum, with postoperative resolution of hypoglycemia. However, 32 years later, the patient experienced a recurrence of hypoglycemic symptoms. Eventually, a subcentimeter extrapancreatic lesion was identified anterior to the pancreatic head on gallium-68 DOTA-Exendin-4 positron emission tomography/computed tomography. In 2022, a third operation was performed, with excision of a 4 × 3 mm tumor adjacent to the pancreatic head, and histology confirming insulinoma. She was again cured of symptoms.

Keywords: Ga-68 GLP-1 PET; insulinoma; pregnancy; recurrence.

Publication types

Case Reports