Abstract:
Hypoglycemia is low blood sugar that could be caused by pancreatic tumors called
insulinomas or islet cell tumors. The incidence is 1–4 per million1. While these tumors are
usually benign, they produce large amounts of insulin, which lowers blood glucose levels. This
is the opposite of the diabetes mellitus in which low insulin levels lead to hyperglycemia.
Insulinomas present with the neuroglycopenic and sympathoadrenal symptoms induced by
hypoglycemia2. Recurrent confusional states are typical of insulinoma. Other symptoms
include visual changes, unusual behavior, palpitations, diaphoresis, and tremulousness3.
Some cases with insulinoma present with neuropsychiatric symptoms and are often
misdiagnosed as psychosis4. In one study, as many as 20% of patients had been misdiagnosed
with a psychiatric, seizure, or other neurological disorder before the true diagnosis of
insulinoma was made5.
Because of its deceptive, disguising and nonpathognomonic symptomatology, insulinoma can
pose a diagnostic dilemma even to a shrewd clinician and remain undiagnosed for years. The
aim of reporting this case is to create clinical awareness among the healthcare professionals in
order to avoid occurrence of a serious mistake in the diagnosis and treatment of insulinoma.