V.M. ATAMANOV, T.P. DEMICHEVA, L.V. KHAZANOVA

Perm State Medical University named after Acad. E.A. Vagner, Perm

Contact details:

Atamanov V.M. ― PhD (medicine), Associate Professor of the Department of Endocrinology and Clinical Pharmacology

Address: 26 Petropavlovskaya Str., Perm, Russian Federation, 614000, tel. (342) 239-32-83, e-mail: atamanov_vm@mail.ru

 The authors present their clinical observations of two patients with malignant insulinoma. Diagnosis of this neuroendocrine tumor was hampered by various neuropsychiatric clinical «masks». Treatment of convulsive and psychopathological states was conducted, but the revealed disorders were not relieved. Only intravenous introduction of a large volume of 40% glucose improved the condition. Patients had a significant increase of insulin and C-peptide level in blood and a tumor-like formation in the pancreatic tail with invasion into the surrounding tissues. In the first case, only symptomatic therapy with somatostatin analogues and intravenous glucose was administered (or the patients consumed a large amount of sweet food). In the second case, in addition to this, cytoreductive distal resection of the pancreatic tail was performed. Hypoglycemic states and coma often occurred in both patients. This may be explained by a large amount of insulin secretion by not only the main tumor, but also metastases.

Key words: neuroendocrine tumors, malignant insulinoma, clinical «masks», hormonal activity, cytoreductive distal pancreatic resection.

(For citation: Atamanov V.M., Demicheva T.P., Khazanova L.V. Malignant insulinoma: from the specific to the general. Practical medicine. 2019. Vol. 17, № 4, P. 162-165)

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