Haba Tomoyuki, Yamakawa Kengo, Ozeki Sayako, Sumida Akira, Kato Takehiro, Kuroda Eiji, Maruyama Takako, Murakami Takaaki, Yabe Daisuke
Division of Diabetes and Endocrinology, Gifu Municipal Hospital, Gifu, Japan.
Department of Diabetes, Endocrinology and Metabolism and Department of Rheumatology and Clinical Immunology, Gifu University Graduate School, 1-1 Yanagido, Gifu, 501-1194 Japan.
Diabetol Int. 2024 Apr 21;15(3):611-615. doi: 10.1007/s13340-024-00722-9. eCollection 2024 Jul.
Insulinomas can present with neuroglycopenic symptoms suggesting neuropsychiatric disorders, delaying diagnosis and treatment. We recently treated a 65-year-old woman with insulinoma who was misdiagnosed at her nearby psychiatric clinic as having schizophrenia because of personality changes and memory impairment; she was treated with brexpiprazole, which was discontinued due to persistence of the symptoms. Despite her relatively low casual plasma glucose (70 mg/dL), the physician at the psychiatric clinic did not investigate the possibility of hypoglycemia, partly because her HbA1c level (5.2%) was within normal range. After skipping lunch one day, she was found by her family to be unable to communicate properly. She was transported to the emergency room of our hospital, where intermittently scanning continuous glucose monitoring (isCGM) use permitted detection of the hypoglycemia and led to a diagnosis of insulinoma and successful resection. A 72-h fasting test established hyperinsulinemic hypoglycemia. Contrast-enhanced computed-tomography and endoscopic ultrasonography together with selective arterial calcium stimulation test revealed an insulin-secreting tumor in the tail of the pancreas. Surgical resection of the tumor corrected her glucose and insulin levels as well as eliminated the insulinoma neuropsychiatric symptoms. Pathological examination showed that the tumor was positive for chromogranin A, synaptophysin and insulin. It is, therefore, important for physicians to be aware that insulinomas can manifest as neuroglycopenic symptoms and to consider the possibility of hypoglycemia by careful medical interview and isCGM, especially when patients suspected of psychiatric disorders do not show the expected response to antipsychotic drugs.
The online version contains supplementary material available at 10.1007/s13340-024-00722-9.
胰岛素瘤可出现神经低血糖症状，提示神经精神疾病，从而延误诊断和治疗。我们最近治疗了一名65岁的胰岛素瘤女性患者，她在附近的精神病诊所被误诊为精神分裂症，原因是性格改变和记忆障碍；她接受了布雷哌唑治疗，但由于症状持续而停药。尽管她的随机血糖相对较低（70mg/dL），但精神病诊所的医生并未调查低血糖的可能性，部分原因是她的糖化血红蛋白水平（5.2%）在正常范围内。一天她没吃午饭，家人发现她无法正常交流。她被送往我院急诊室，通过使用间歇性扫描连续血糖监测（isCGM）检测到低血糖，从而诊断为胰岛素瘤并成功切除。72小时禁食试验确诊为高胰岛素血症性低血糖。增强CT、内镜超声以及选择性动脉钙刺激试验显示胰腺尾部有一个胰岛素分泌肿瘤。手术切除肿瘤纠正了她的血糖和胰岛素水平，并消除了胰岛素瘤的神经精神症状。病理检查显示肿瘤嗜铬粒蛋白A、突触素和胰岛素均呈阳性。因此，医生必须意识到胰岛素瘤可表现为神经低血糖症状，并通过仔细的病史询问和isCGM来考虑低血糖的可能性，尤其是当疑似精神疾病的患者对抗精神病药物未表现出预期反应时。
在线版本包含可在10.1007/s13340-024-00722-9获取的补充材料。
