Holiday Insulinoma

Abstract

An uncommon case of insulinoma is presented. The patient is a 59-year-old, hard-working director of a large industrial consortium. Serum glucose dropped to extremely low levels that approached the range considered to be lethal in most humans. Symptoms presented themselves only on days the patient was free from work.

Laboratory tests revealed permanent asymptomatic hypoglycemia with serum glucose ranging from 45 to 50 mg/dL. When the patient sought medical advice because of malaise, he was found to suffer from episodes of hypoglycemia with serum glucose levels as low as 16 mg/dL with a concomitant rise in insulin and C peptide levels. Because of the nature of his occupation, the patient was subject to constant intense stress accompanied by secondary hypercortisolemia. The elevated cortisol level ensured that his serum glucose level was high enough to maintain intellectual and physical competence while at work. However, when he was not working, the lack of stress reduced his cortisol level to the point that it no longer compensated for his chronic hypoglycemia. It was then that symptoms appeared. The patient experienced symptoms of neuroglycopenia on 2 occasions.