Insulinoma Unmasked Post Sleeve Gastrectomy With Incidental Renal Cell Carcinoma: A Rare Case

Insulinoma Unmasked Post Sleeve Gastrectomy With Incidental Renal Cell Carcinoma: A Rare Case

Insulinoma is a functional pancreatic neuroendocrine tumor (pNET). Usually benign and solitary, these tumors present with recurrent episodes of hypoglycemia due to insulin hypersecretion. It's a rare cause of post bariatric surgery hypoglycemia and hence poses a diagnostic challenge. Here, we r...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) Vol. 16; no. 5; p. e60395
Main Authors: Goel, Yashika, Kurlekar, Utkrant, Chitharanjan, Ashish, Beke, Amruta N
Format: Journal Article
Language:English
Published: United States Cureus Inc 15-05-2024
Cureus
Subjects:
Abdomen
Asymptomatic
Case reports
Endoscopy
Fasting
Gastroenterology
Gastrointestinal surgery
General Surgery
Glucose
Histopathology
Hypoglycemia
Insulin resistance
Kidney cancer
Localization
Medical imaging
Neuroendocrine tumors
Pancreas
Pancreatic cancer
Patients
Peptides
Small intestine
Ultrasonic imaging
Urology
von hippel-lindau syndrome (vhl)
pancreatic neuroendocrine tumor (pnet)
renal cell carcinoma (rcc)
insulinoma
post bariatric surgery hypoglycemia
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Summary:Insulinoma is a functional pancreatic neuroendocrine tumor (pNET). Usually benign and solitary, these tumors present with recurrent episodes of hypoglycemia due to insulin hypersecretion. It's a rare cause of post bariatric surgery hypoglycemia and hence poses a diagnostic challenge. Here, we report the first case of a 53-year-old male with insulinoma unmasked post sleeve gastrectomy with incidental renal cell carcinoma (RCC). He presented with symptoms of Whipple's triad after two months of sleeve gastrectomy done for morbid obesity. On further inquiry, the patient gave a history of an asymptomatic peripancreatic neuroendocrine tumor (NET) for the past 11 years. With a suspicion of insulinoma, biochemical workup followed by non-invasive imaging like GA-68 DOTA and CT triphasic abdomen scan was done to guide the diagnosis of an insulinoma which also detected a second primary tumor in the right kidney, likely to be a malignant RCC. Following pancreatic mass excision with radical nephrectomy for right renal mass, histopathology (HPE) and immunohistochemistry (IHC) confirmed the diagnosis of an insulinoma and a right renal clear cell carcinoma. The patient was discharged with no further episodes of hypoglycemia. Hence, persistent hypoglycemia post bariatric surgery could be an indication of a hidden insulinoma and this possibility of synchronous tumors should be kept in mind when dealing with rare tumors like insulinoma.
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ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.60395