Metastatic insulinoma: case report and review of the literature.

A 64-year-old nondiabetic woman presented with spells of lightheadedness and diaphoresis associated with lethargy and hunger of 2 weeks' duration. Physical examination was unremarkable; however, her fasting plasma glucose was 66 mg/dl, with concurrent plasma insulin of 171 microIU/ml (normal, 5-27 microIU/ml). Her C-peptide and pro-insulin levels were elevated, with negative insulin antibody and negative urinary sulfonylurea levels. Abdominal computed tomographic scan demonstrated a 5 x 4-cm mass in the tail of the pancreas and many liver metastases. She underwent resection of the pancreatic mass, radiofrequency ablation, and cauterization of hepatic lesions. Histology confirmed pancreatic insulinoma. Ten months later, she was free of hypoglycemic symptoms, with normal plasma insulin C-peptide and significantly decreased proinsulin levels. Insulinomas are rare, predominantly benign tumors. Surgery is the only curative treatment. Octreotide can be used to control hormone secretion and tumor growth. Other treatments include hepatic embolization, radiotherapy, chemotherapy, and liver transplantation.