DOI: 10.36347/sasjm.2022.v08i03.007

Pages: 150-153

Insulinoma is an insulin-secreting pancreatic tumor responsible for hypoglycemia. It is a rare tumor that occurs in 1 to 4 persons / million in the population and represents 1 -2% of pancreatic tumors. The diagnosis is made by demonstrating, insulin secretion by measuring insulin levels and C-peptide in the presence of hypoglycemia and by demonstrating a pancreatic tumor by pancreatic CT and/or pancreatic MRI [5]. Surgical resection is the main modality for the treatment of insulinomas [1]. We report 2 observations of an insulinoma. A 47 year old patient, who consulted us for lipothymia associated with cold sweats and hunger, occurring preferably in the morning between 6 and 7 o’clock, The blood sugar level taken at the time of the malaise was 0.35 g/l. Assessment performed : Insulinemia ↑ : 701 pmol/l (18 -173), Peptide C↑: 2,35 pmol/ml ( 0,3- 1,4) in comparison with a hypoglycemia at 0,35 g/l. Abdominal MRI revealed a 16×16 mm nodule in the isthmus of the pancreas with poor vascularity compatible with an insulinoma. Observation 2: patient, 37 years, admitted for investigation and management of hypoglycemia ranging from 0.3 g/l occurring during physical activity. Workup performs: fasting test: peptide C↑: 3 ng/ml (1.1-1.47), insulinemia: 22.6 mUI/l (2.6- 24.9) vs. hypoglycemia 0.50 g/l, insulin/glycemia ratio=0.45 (normal <0.3), turner index:113 (normal <50). Normal abdominal CT scan completed by pancreatic MRI: pancreatic nodule in the isthmic region of 13*8 mm compatible with an insulinoma. Octreoscan: a hyperfixing focus on an isodense nodule of the head-neck junction of the pancreas measuring approximately 12*13 mm compatible with an insulinoma. Surgical management: enucleation. favorable evolution marked by the disappearance of hypoglycemia.