Recurrent hypoglycemic seizures and obesity: delayed diagnosis of an insulinoma in a 15 year-old boy--final diagnostic localization with endosonography.

Insulinoma in children and adolescents is extremely rare. In adults diagnosis is frequently delayed due to frequent neuropsychiatric symptoms that are misunderstood. Diagnostic localization is sometimes extremely difficult. We present a case of insulinoma with onset of symptoms at the age of 12.5 years. Diagnosis was made very soon after the first symptoms, but diagnostic localization was delayed, since conventional MRI did not reveal the insulinoma. The patient suffered from recurrent hypoglycemic seizures and gained 54 kg in weight until diagnostic localization was made with abdominal MRI, octreotate-PET and finally successful endosonography. A solitary insulinoma in the pancreatic tail was enucleated laparoscopically.