Abstract:
BACKGROUND:The coexistence of insulin and ACTH hypersecretion in the same patient is extremely rare. A diabetic patient with a pancreatic endocrine tumor (PET) co-secreting insulin and ACTH is even rarer and has never been described. The combination of these two endocrine syndromes results in a peculiar clinical picture. AIM:To determine the cause of glycemic variations in a patient with previously stable diabetes mellitus. SUBJECTS AND METHODS:This is a clinical case report from the Endocrinology Unit of Aosta Hospital and Internal Medicine and Surgical Unit of Verona University. A 69-yr-old diabetic patient was hospitalized for recurrent severe hypoglycemic events persistent after withdrawal of anti-diabetic drugs. The causes of hypoglycemia and subsequent resumption of hyperglycemia were investigated. RESULTS:An insulin-secreting PET was diagnosed. Diazoxide and octreotide therapy initially was able to control hypoglycemic symptoms, then, a Cushing's syndrome occurred resulting in worsening of diabetes control. ACTH was found to be released by the PET previously diagnosed as an insulin-secreting tumor. The tumor was removed and the histology was consistent with a well differentiated endocrine carcinoma. After surgery, adrenal function was normal and insulin therapy was again necessary to control diabetes. CONCLUSIONS:A single PET may be responsible for both a hyperinsulinemic and a Cushing's syndrome. When this rare association occurs, each of the two syndromes may affect the other resulting in a peculiar clinical course. Finally, an insulin-secreting PET has to be kept in mind as a rare cause of hypoglycemia in diabetic patients.
journal_name
J Endocrinol Investjournal_title
Journal of endocrinological investigationauthors
Filippella M,Davì MV,Doveri G,Lillaz E,Ciccarelli A,Massimetti E,Toaiari M,Falconi M,Colao A,Faggiano Adoi
10.1007/BF03347062subject
Has Abstractpub_date
2011-03-01 00:00:00pages
175-9issue
3eissn
0391-4097issn
1720-8386pii
6975journal_volume
34pub_type
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