Diagnostic pitfall in hypoglycemia: Insulinoma in tail of pancreas

Insulinomas, a rare kind of tumors are the most common cause of endogenous hyperinsulinsm with patients presenting with the classical Whipple’s triad.
We present a patient with neurohypoglycemic symptoms undergoing neurological/psychiatric evaluation in multiple hospitals. A detailed workup in our hospital revealed a small tumor in the tail of pancreas and enucleation of tumor was successfully performed. After surgery, patient’s symptoms were resolved and patient did not report any episodes of hypoglycemia during 3 months follow-up period.
Diagnosis of insulinoma is difficult due to its low incidence and presence of neuroglycopenic symptoms. Patients tend to seek neurology opinion early on and in many cases the diagnosis is delayed due to futile search for neurological or psychiatric illnesses. Hence a multimodal approach including endocrinologist, surgeons, radiologist and pathologist is required.