Insulinoma complicating pregnancy presenting with hypoglycemic coma after delivery: a case report and review of the literature.

The incidence of insulinoma in pregnancy is unknown. All of the eight previously reported cases presented in the first trimester with hypoglycemic episodes. We report a case of a 24-year-old multigravida who presented with hypoglycemic coma after delivery. We discuss the possible protective role of pregnancy counter-regulatory hormones in keeping the patient asymptomatic until delivery, and present the difficulties in both diagnosis and differential diagnosis of insulinoma in the peripartum period. Chronic hypoglycemia in pregnancy has been associated with intrauterine growth retardation and increased perinatal mortality. However, this infant was at the 90th percentile for body weight, suggesting that asymptomatic maternal hypoglycemia had not been present during the gestation. Insulinoma complicating pregnancy, though very rare, should now be included in the differential diagnosis of postpartum hypoglycemia.