Curbside Consultation in GI Cancer for the Gastroenterologist: 49 Clinical Questions

Douglas G. Adler, MD

Question 16: A 43-Year-Old Woman Has Syncope Due To Hypoglycemia. An Insulinoma Is Suspected. Computed Tomography And Magnetic Resonance Imaging Of Her Abdomen Are Negative. How Should This Patient Be Further Evaluated? (continued)

Sergey V. Kantsevoy, MD, PhD

Insulinomas are the most common hormone-secreting tumors, accounting for 60% of all pancreatic neuroendocrine tumors.1 Patients with insulinomas usually present with clinical hypoglycemia, described by characteristic Whipple’s triad of neurogenic (tremor, palpitation, anxiety, sweating, hunger, paresthesias) and neuroglycopenic symptoms (cognitive impairment, syncope, and behavioral changes often progressing to seizures and coma if untreated) associated with low blood glucose concentration. Most patients have prompt relief of all symptoms after the plasma glucose level is raised (by…