1/5. Lessons to be learned: a case study approach insulinoma presenting as a change in personality.A 43-year-old man presented with attacks of altered behaviour over a short period of time; they were associated with episodes of hypoglycaemia. The clinical suspicion of insulinoma prompted investigations that quickly established serum insulin and c-peptide levels to be elevated at the times when blood glucose values were low. A physical lesion was found in the head of the pancreas by means of computerised tomography and endo-duodenal ultrasound scan; an octreotide scan was negative. The patient underwent laparotomy and enucleation of a benign tumour, measuring 2.6 cm in diameter, lying within the head of the pancreas; histological examination confirmed it to be an insulinoma. Postoperatively, the patient's personality gradually became more normal and his fasting blood glucose concentrations returned to within normal limits. The diagnosis and management of insulinoma are discussed in the context of this clinical case; there is also reference to the protean clinical manifestations that may occur in this condition- and its differential diagnosis.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
2/5. insulinoma.A case of insulinoma who had episoic bizarre behaviour is presented here. Pre-operative fasting and two hour post-prandial blood sugar values indicated hypoglycemia with inappropriately high insulin levels. USG and CT scan of the abdomen revealed a tumor of head of the pancreas. The tumour was enucleated surgically. Histopathological examination confirmed the origin as islet cells. The post-operative blood sugar and insulin levels were found to be in normal range. Since insulinoma is a rare pancreatic tumor, differential diagnoses along with a brief review of the literature is also presented.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
3/5. Malignant insulinoma presenting with recurrent episodic loss of consciousness.A 57 year old male presented with episodic behavioural abnormalities and loss of consciousness for 2 years. His fasting blood glucose was 20 mg/dl and corresponding insulin level 119 uU/ml. His EEG showed intermittent rhythmic delta activity. Abdominal CT scan revealed an enhancing mass in the tail of the pancreas and secondaries in the liver. After distal pancreatectomy, resection of the left lobe of the liver and chemotherapy, the hypoglycaemic spells subsided. Histopathology revealed an islet cell tumour with metastases in the liver. Episodic neurobehavioural dysfunction should alert towards the possibility of hypoglycaemia.- - - - - - - - - - ranking = 2keywords = behaviour (Clic here for more details about this article) |
4/5. A case of multiple endocrine adenomatosis type 1.A case of pituitary adenoma associated with pancreatic islet cell tumor is presented. A 29-year-old man with symptoms of confusion and abnormal behaviour was admitted to the neurosurgical department. He was diagnosed as suffering from multiple endocrine adenomatosis (MEA) type 1. Screening of his family members revealed that his mother had high levels of gastrin, glucagon and parathormone and his father had a high level of gastrin. The pituitary adenoma and pancreatic tumor were removed satisfactorily. family members as well as the patient should be checked periodically.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
5/5. Case of the month: a case of forgetfulness?An obese 24-year-old man was admitted following a road traffic accident, during which he crashed into several cars and a shop. He had not been drinking alcohol, yet did not recall the incident. The family had noticed recent odd behaviour, episodic aggression and a glazed look at times. Apart from a minor whiplash injury, he was uninjured and clinically normal. A computed tomography (CT) head scan and encephalo-electrography were both normal. Routine investigations were unremarkable apart from a fasting glucose 0.9 mmol l-1. In view of the presenting symptoms and fasting hypoglycaemia, a CT scan of the abdomen was performed (Figure 1). What does this show?- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |