Altered behavior with an organic cause: a case report
This case has been published in Journal of medical case reports.

Insulinomas represent over 50% of pancreatic tumors but affect less than 10/1,000,000 people per year, resulting in misdiagnosis as psychiatric or neurologic disease in up to 20% of patients, and they remain symptomatic for up to 2 years before diagnosis.

A 50-year-old Hispanic man with known history of obesity and hypertension presented with a 3-month history of abrupt episodes of weakness and altered mental status. He referred severe psychomotor symptoms as well as anxiety, aggressiveness, agitation, weakness, diaphoresis, and decreased visual acuity occurring at any time of the day and improved by eating.

During the following weeks, the symptoms increased in severity and frequency, with continued unremitting anxiety and weakness accompanied by loss of consciousness and extreme burning sensation in his entire body. After this acute episode, he was evaluated by a primary care physician in a local hospital and hospitalized for 4 days, where he continued to present recurrent episodes of irritability and aggression to self and others. He was discharged and referred for psychologic evaluation by mental health services at another institution. No specific diagnoses were given.

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