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Image of the Month—Quiz Case
D. Dean Potter, MD;
Patrick D. Munson, MD;
Clive S. Grant, MD
Author Affiliations: Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, Minn.
Arch Surg. 2005;140:611.
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INTRODUCTION
A 45-year-old woman presented with a 3-year history of confusion and seizures refractory to anticonvulsant therapy. A biochemical diagnosis of excess endogenous insulin production was established by a serum glucose level of 46 mg/dL, serum insulin level of 4 µIU/mL, C-peptide level of 0.9 ng/mL, proinsulin level of 19.9 pmol/L, and a negative sulfonylurea screen. Her neuroglycopenic symptoms were relieved by intravenous glucose administration. She had no history of peptic ulcer disease (serum gastrin level of <25 pg/mL), nipple discharge, or hypercalcemia (serum calcium level of 9.6 mg/dL). By preoperative transabdominal ultrasound, a 1-cm hypervascular mass was identified in the body of the posterior pancreas (Figure 1). She was taken to the operating room for enucleation of a well-circumscribed 7-mm insulinoma that was confirmed by immunohistochemical staining. No additional masses were identified intraoperatively by palpation. Her . . . [Full Text of this Article]
What Is the Diagnosis?
RELATED ARTICLE
Image of the Month—Diagnosis
Arch Surg. 2005;140(6):612.
EXTRACT
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