Insulinoma with a History of Epilepsy: Still a Possible Misleading Factor in the Early Diagnosis of Insulinoma

Takaaki Murakami; Takafumi Yamashita; Daisuke Yabe; Toshihiko Masui; Yuki Teramoto; Sachiko Minamiguchi; Keisho Hirota; Masahito Ogura; Kazuaki Nagashima; Nobuya Inagaki

doi:10.2169/internalmedicine.8932-17

CASE REPORTS

Insulinoma with a History of Epilepsy: Still a Possible Misleading Factor in the Early Diagnosis of Insulinoma

Takaaki Murakami, Takafumi Yamashita, Daisuke Yabe, Toshihiko Masui, Yuki Teramoto, Sachiko Minamiguchi, Keisho Hirota, Masahito Ogura, Kazuaki Nagashima, Nobuya Inagaki

Author information

Takaaki Murakami
Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Japan
Takafumi Yamashita
Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Japan
Daisuke Yabe
Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Japan
Toshihiko Masui
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University Graduate School of Medicine, Japan
Yuki Teramoto
Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine, Japan
Sachiko Minamiguchi
Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine, Japan
Keisho Hirota
Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Japan
Masahito Ogura
Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Japan
Kazuaki Nagashima
Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Japan
Nobuya Inagaki
Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Japan

Keywords: insulinoma, epilepsy, continuous glucose monitoring, hypoglycemia, misdiagnosis, anti-epileptic drug

JOURNAL OPEN ACCESS

2017 Volume 56 Issue 23 Pages 3199-3204

DOI https://doi.org/10.2169/internalmedicine.8932-17

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Abstract

A delayed diagnosis of insulinoma remains a clinical issue. Hypoglycemic symptoms can mimic neuropsychiatric disorders such as epilepsy. A 27-year-old woman with a history of epilepsy and anti-epileptic drugs (AEDs) developed repeated seizures and neuropsychiatric symptoms after a 9-year asymptomatic interval. She had received transient treatment with AEDs before the possibility of hypoglycemia was considered. Following a clinical diagnosis of insulinoma, distal pancreatectomy was performed; her seizures didn't occur again. The early diagnosis of insulinoma requires vigilance not only for hypoglycemia in patients with neuropsychiatric symptoms but also for the possible masking effects of a history of epilepsy and preceding AED usage.

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