A 36-year-old male, previously healthy, with no family history of diabetes, began with episodes of tremor, sweating, weakness of extremities and syncope of six months of evolution, which appeared on fasting exercise and resolved with exercise.
Neurological control was established due to probable epilepsy. She was treated with carbamazepine several weeks without other drugs.
For a new episode of loss of consciousness, the patient was admitted to the emergency department with recurrent hypoglycemia, less than 35 mg/dl, and was hospitalized.
Physical examination was normal, without acanthosis nigricans and body mass index was 25.6 kg/m2.
Thyroid function and morning cortisol levels were normal.
An oral glucose tolerance test (OGTT) reported basal glycemia of 88 and at 120 min 185 mg/dl, basal insulinemia of 2,759 and at 120 min of 5,942 μUI/ml.
Fasting test showed 46 mg/dl glycemia and 588 μUI/ml insulinemia (RIA, Diagnostic Products, Co [DPC]) at 15 hours of fasting, with associated symptoms.
An abdominal computed axial tomography (CAT) was normal.
A selective intra-arterial stimulation test with calcium was carried out to locate insulinomas according to protocol2, which did not allow the localization and in the arteriography a possible nodular lesion in the head of the pancreas was described, of 1,7 x 1,4 cm.
Insulin antibodies were measured by enzyme immunoassay (ELISA) with positive commercial kits Medizym® (Medipan GmbH, Ber, Germany).
Antithyroid and antinuclear antibodies were negative.
No other autoimmune disease was observed.
1.
He was treated with restricted diet consisting of refined carbohydrates and frequent meals in small quantities, remaining asymptomatic, without presenting new hypoglycemia.
At one year of follow-up, GDT was performed, which reported basal glycemia 84 and at 120 min 240 mg/dl and basal insulinemia of 434 and at 120 min 793 μUI/ml (RIA).
The patient remained asymptomatic after three years of follow-up.
