Insulinoma in a young female patient with systemic lupus erythematosus: a case report.

OBJECTIVE Fasting hypoglycemia may occur in subjects with systemic lupus erythematosus (SLE) when accompanied with insulin-binding antibodies or insulin-receptor antibodies. However, insulinoma has not been reported in SLE subjects with hypoglycemia. METHODS We present a case report and review the relevant literature. RESULTS A 26-year-old female with underlying SLE experienced several episodes of neuropsychiatric symptoms in a fasting state. The steroid dosage was titrated up, but in vain. Timely imaging studies showed a pancreatic tumor, and insulinoma was proven by pathology. Hypoglycemia did not recur after surgery. CONCLUSION Physicians should distinguish insulinoma from autoimmunity-mediated hypoglycemia in SLE patients with fasting hypoglycemia.

[1]  A. Schneebaum,et al.  Systemic lupus erythematosus presenting as hypoglycemia with insulin receptor antibodies. , 1989, The Western journal of medicine.

[2]  Y. Omori,et al.  Insulin autoimmune syndrome (Hirata disease): clinical features and epidemiology in Japan. , 1994, Diabetes research and clinical practice.

[3]  L. Opas,et al.  Systemic lupus erythematosus with acanthosis nigricans, hyperpigmentation, and insulin receptor antibody , 1997, Lupus.

[4]  P. Govender,et al.  Multimodality preoperative imaging of pancreatic insulinomas. , 2005, Clinical radiology.

[5]  J. Masjhur.  Insulin Autoimmune Syndrome (Hirata's disease): severe hypoglycemic episodes in Graves' hyperthyroidism patient treated with methimazole. , 2005, Acta medica Indonesiana.

[6]  Kam‐Tsun Tang,et al.  Severe hypoglycemic coma due to insulin autoimmune syndrome. , 2005, Journal of the Chinese Medical Association : JCMA.

[7]  R. Semelka,et al.  Imaging and localization of islet-cell tumours of the pancreas on CT and MRI. , 2005, Best practice & research. Clinical endocrinology & metabolism.

[8]  Y. Kitajima,et al.  A case of systemic lupus erythematosus presenting as hypoglycemia due to anti-insulin receptor antibodies , 2008, Rheumatology International.

[9]  P. Cryer,et al.  Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline. , 2009, The Journal of clinical endocrinology and metabolism.

[10]  T. Metens,et al.  Successful preoperative localization of a small pancreatic insulinoma by diffusion-weighted MRI. , 2009, JOP : Journal of the pancreas.

[11]  Y. Qing,et al.  Systemic lupus erythematosus presenting as hypoglycaemia with insulin receptor antibodies and insulin autoantibodies , 2009, Lupus.

[12]  E. Jüttler,et al.  Hypoglycemic encephalopathy: a case series and literature review on outcome determination , 2012, Journal of Neurology.

[13]  Y. Ogawa,et al.  Diagnosis and management of insulinoma. , 2013, World journal of gastroenterology.

[14]  P. Iglesias,et al.  Management of endocrine disease: a clinical update on tumor-induced hypoglycemia. , 2014, European journal of endocrinology.