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The Journal of the Royal Society for the Promotion of Health
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Lessons to be learned: a case study approach Insulinoma presenting as a change in personality

Stella Vig, BSc, MB, BCh, FRCS

Department of Surgery, East Surrey Hospital, Redhill, Surrey RH1 5RH, England

Mark Lewis, MB, BS, MRCS

Department of Surgery, East Surrey Hospital, Redhill, Surrey RH1 5RH, England

Kenneth J. Foster, DM, FRCP

Department of Medicine, East Surrey Hospital, Redhill, Surrey RH1 SRH, England

Adam Stacey-Clear, BSc, MS, FRCS

Department of Surgery, East Surrey Hospital, Redhill, Surrey RH1 5RH, England

A 43-year-old man presented with attacks of altered behaviour over a short period of time; they were associated with episodes of hypoglycaemia. The clinical suspicion of insulinoma prompted investigations that quickly established serum insulin and C- peptide levels to be elevated at the times when blood glucose values were low A physical lesion was found in the head of the pancreas by means of computerised tomography and endo-duodenal ultra sound scan; an octreotide scan was nega tive. The patient underwent laparotomy and enucleation of a benign tumour, mea suring 2.6 cm in diameter, lying within the head of the pancreas; histological examina tion confirmed it to be an insulinoma. Post operatively, the patient's personality gradu ally became more normal and his fasting blood glucose concentrations returned to within normal limits. The diagnosis and management of insulinoma are discussed in the context of this clinical case; there is also reference to the protean clinical mani festations that may occur in this condition- and its differential diagnosis.

Key Words: Clinical presentation • diagnosis • hypoglycaemia • insulinoma • localisation • treatment

The Journal of the Royal Society for the Promotion of Health, Vol. 121, No. 1, 56-61 (2001)
DOI: 10.1177/146642400112100112
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