Insulinoma Identified in Puerperium: Association with Pregna
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Although insulinomas are extremely rare during pregnancy, most cases are recognized or become symptomatic during the first trimester. Symptoms of insulinomas may be initially masked due to changes in glucose metabolism and insulin resistance associated with pregnancy. In pregnancy, surgical treatment should be avoided whenever possible because of the risks to both mother and fetus; conservative treatment, including dietary intake, intravenous glucose, and glucagon, should be initiated to control the hypoglycemia symptoms.

Insulinomas are functional neuroendocrine tumors derived from the beta cells of the pancreatic islets of Langerhans, usually solitary, benign and curable with surgery (enucleation), and which cause non-ketotic hypoglycemia. It has an estimated incidence of four cases per million person-years. Although insulinomas are extremely rare during pregnancy, most cases are recognized or become symptomatic during the first trimester. Insulinomas are the most frequent functioning endocrine pancreatic tumors, which may present as malignant in 10% of cases. About 10% of insulinomas are associated with MEN 1.

This report is about the case of a 34-year-old woman who experienced neuroglycopenia 2 days after delivery. Corresponding to severe hypoglycemia, inappropriately elevated insulin and C-peptide levels were found. Following magnetic resonance imaging, a lesion of 10x8 mm was detected in the head of the pancreas. Ultrasound-guided fine-needle aspiration of the mass confirmed the diagnostic suspicion of a pancreatic neuroendocrine tumor. Complete surgical enucleation of the insulinoma resulted in immediate and permanent resolution of the hypoglycemia. The postoperative course was uneventful. Histopathological and immunohistochemical analyses were consistent with insulinoma. The diagnostic approach to postpartum hypoglycemia represents a challenge for multidisciplinary teamwork.

Source: https://www.ejcrim.com/index.php/EJCRIM/article/view/1556/1999
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