Giant insulinoma: an unusual cause of hypoglycaemia

Description 

A 70-year-old non-diabetic man presented to the accident and emergency department with convulsions and symptoms of hunger, anxiety and blurred vision. A non-tender epigastric mass was identified, and he was found to be hypoglycaemic, with plasma glucose levels of 1.5 mmol/L (4.4–6.1 mmol/L). C-peptide and insulin levels were both inappropriately elevated.

After stabilisation with glucose, the patient was investigated with CT, which revealed a 154 mm mass in the pancreas that displaced the stomach and encased the coeliac trunk, the superior mesenteric vein and the splenic vein (figure 1). Collaterals were found at the level of the hepatic hilum, the gastro-oesophageal junction and adjacent to the mass itself. Calcifications typical of insulinomas were evident (figure 2). No metastases were seen. Fine-needle aspiration was then performed, confirming the diagnosis (figure 3).

Figure 1

Multiplanar reconstruction identifying the 154 mm insulinoma.

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