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Arch Surg. 2005;140:612.

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Answer: A Second Insulinoma

To establish a definitive diagnosis of insulinoma, the following 4 criteria must be met: (1) neuroglycopenic symptoms with a documented blood glucose level less than or equal to 45 mg/dL and relief of the patient’s symptoms with glucose administration, (2) concomitant inappropriately elevated insulin levels (6 µIU/mL by radioimmunoassay or 3 µIU/mL by immunochemiluminescent assay), (3) elevated C-peptide levels (0.2 nmol/L), and (4) absence of sulfonylurea in the plasma.^1-2 Laboratory values in our patient effectively ruled out Munchausen syndrome because of a negative sulfonylurea screen and an appropriately elevated C-peptide value. Therefore, endogenous causes for recurrent hypoglycemia were sought.

Data from our institution indicate that 3% (6/185) of patients with sporadic insulinoma have multiple tumors.^3-4 Transabdominal ultrasound was repeated but failed to detect any abnormality within the gland. An ultrasound is our initial preoperative test of choice for the identification of insulinoma because it has a sensitivity approaching . . . [Full Text of this Article]

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