c-peptide and Mental-Disorders

A 43-year-old man presented with attacks of altered behaviour over a short period of time; they were associated with episodes of hypoglycaemia. The clinical suspicion of insulinoma prompted investigations that quickly established serum insulin and C-peptide levels to be elevated at the times when blood glucose values were low. A physical lesion was found in the head of the pancreas by means of computerised tomography and endo-duodenal ultrasound scan; an octreotide scan was negative. The patient underwent laparotomy and enucleation of a benign tumour, measuring 2.6 cm in diameter, lying within the head of the pancreas; histological examination confirmed it to be an insulinoma. Postoperatively, the patient's personality gradually became more normal and his fasting blood glucose concentrations returned to within normal limits. The diagnosis and management of insulinoma are discussed in the context of this clinical case; there is also reference to the protean clinical manifestations that may occur in this condition- and its differential diagnosis.

Topics: Adult; Blood Glucose; C-Peptide; Diagnosis, Differential; Dizziness; Endosonography; Humans; Hypoglycemia; Insulin; Insulinoma; Male; Mental Disorders; Pancreatic Neoplasms; Personality; Tomography, X-Ray Computed

3 patients with recurrent, symptomatic hypoglycemia associated with increased insulin and C-peptide blood levels are described. 2 men aged 37 and 21-years had mental and social problems and although they had access to sulfonylurea drugs, both denied intake. 1 was scheduled for pancreatectomy, but as a result of the vigilance of the surgeon, the operation was canceled. By demonstrating sulfonylurea in their urine, a definitive diagnosis of factitious hypoglycemia was established, and further invasive procedures were avoided. The third was a woman aged 40-years had malignant insulinoma with liver metastases, proven by cytology. The common and differentiating clinical and laboratory characteristics of hypoglycemia due to insulinoma and factitious hypoglycemia secondary to sulfonylurea intake are discussed, and the importance of urine analysis demonstrating the presence of sulfonylurea is emphasized.

Topics: Adult; C-Peptide; Diagnosis, Differential; Factitious Disorders; Female; Humans; Hypoglycemia; Insulin; Insulinoma; Male; Mental Disorders; Pancreatic Neoplasms; Sulfonylurea Compounds