| Popis: |
Introduction Proinsulin-secreting tumors (proinsulinomas) are exceedingly rare, characterized by the predominant hypersecretion of proinsulin. We present an unusual case of hypoglycemic syndrome in a 19-year old woman with a proinsulinoma (PI). Clinical Case 19-year-old female presented mild neuroglycopenic symptoms (SX) while having sexual intercourse with her husband at their honeymoon. Her condition began with diaphoresis, blurred vision, tremors and anxiety ending in somnolence that appeared exactly during sexual intercourse and disappear with orange juice intake. The SX kept appearing every time she had intercourse during the next month, denying that any other situation triggered them. She was referred to psychiatry where she was diagnosed with erotophobia and treated with fluoxetine and alprazolam. She gained 33 pounds and referred her husband gave her chocolate bars during sexual intercourse so SX wouldn’t appear. 5 months later she presented cognitive deterioration characterized by stupor during intercourse, so she was taken to the emergency department (ED). Arrived the ED with tachycardia (110 bpm), BP 140/90 mmHg, stuporous, diaphoretic, pale and with a 27mg/dl blood glucose (BG). The patient was admitted to the hospital for further evaluation. After 12 hours of insulin fasting test, she began with SX and a 32 mg/dl glycometry was registered, the test was stopped afterwards. Serum labs were obtained: BG 28 mg/dl, insulin 3 (n 3.0-25.0Uiu/ML), C-peptide 0.9 (n 0.8-3.0ng/ml), proinsulin 298 (≤ 18.8 pmol/L). Abdominal CT scan in arterial phase revealed a single round, hypervascular image, located in the pancrea’s body, 1.96 x 1.37 x 1.42 cm and 123 HU. Enucleation of the mass was performed. The histopathological report showed a neuroendocrine neoplasia and chromogranin positive immunohistochemistry in the neoplastic cells. Patient presented complete clinical remission, fluoxetine and alprazolam were discontinued and she lost 35 pounds in the next 6 months. Conclusion PI are predominantly benign neuroendocrine tumors that have the potential to cause symptomatic hypoglycemia. The patient’s clinical manifestations were confused with an anxious syndrome and erotophobia, and these cases illustrate that the diagnosis of organic hypoglycemia can be challenging. |
