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Requests for reprints should be addressed to Daniel Varela, MD, Division of General Internal Medicine, University of Colorado School of Medicine, 8th Floor, Academic Office 1, Mailstop B180, 12631 East 17th Avenue, Aurora, CO, USA 80045.
A 55-year-old man presented with 6 months of increasingly frequent episodes of confusion
and abnormal behavior (Video 1). Neurologic examination and diagnostic work-up were unremarkable. He was evaluated
for stroke, Huntington's disease, conversion disorder, and other neuropsychiatric
conditions without a satisfactory diagnosis. Months later, he suffered another episode
and was found to have a glucose of 33 mg/dL. This improved with glucose administration
but rapidly dropped to 30 mg/dL. A 72-hour fast, which revealed a low serum glucose
and elevated insulin, pro-insulin, and C-peptide levels, strongly suggested the diagnosis
of insulinoma. Contrast computed tomography (CT) revealed a suspicious pancreatic
mass (Figure 1), and endoscopic ultrasound-guided fine needle aspiration confirmed the diagnosis.
The patient was cured of his symptoms following distal pancreatectomy (Figure 2).
Figure 1Contrast abdominal computed tomography scan with pancreas protocol demonstrating an
arterial enhancing 1.6×1.2-cm mass in the pancreatic tail, consistent with insulinoma.
Authorship: All authors had access to the data and a role in writing this manuscript.
Patient Consent: The patient has provided written consent to publish his case and details of his hospitalization, including video documentation and results of imaging studies and gross pathology.
