Page 29 - HKSEMR2020 Programme book

Poster Presentation (Clinical) Abstracts

Insulinoma co-existing with type 2 diabetes mellitus treated with

endoscopic ultrasound-guided radiofrequency ablation

Johnny Yau-Cheung Chang, Chariene Shao-Lin Woo, David Tak-Wai Lui, Matrix Man-Him
Fung, Ka-Wing Ma, Alan Chun-Hong Lee, Yu-Cho Woo, Wing-Sun Chow, Kathryn Choon-
Beng Tan, Karen Siu-Ling Lam, Chi-Ho Lee
Queen Mary Hospital

Introduction / Background / Objectives: was confirmed biochemically. Computed tomography (CT) of the
abdomen showed a 1.2 x 0.9-cm arterial enhancing lesion at the
Insulinoma is an uncommon condition with an incidence of 4
cases per 1 million person-years. Although the pathologies behind pancreatic head. The remaining pancreas appeared mildly atrophic.
insulinoma and diabetes mellitus may seem contradictory, with Positron emission tomography-CT showed a vague DOTATATE-avid
recurrent refractory hypoglycaemia predominating in the former neuroendocrine tumour lesion measuring 1.26 x 0.94-cm (SUV
while fasting and post-prandial hyperglycaemia characterize the max 9.7) at the pancreatic head.
latter, their coexistence has been occasionally reported in the
literature. In a retrospective study conducted by Mayo Clinic, Results / Outcomes:
there was one known case of insulinoma with concomitant
diabetes mellitus out of 313 cases in a 65-year period. Endoscopic The patient was initially managed with dietary modification
ultrasound (EUS)-guided radiofrequency ablation (RFA) is a non- and corn starch overnight, followed by EUS-guided RFA of his
surgical alternative for definitive treatment of insulinoma. We insulinoma as curative therapy. Post-treatment, he has resolution
describe a case of concomitant diabetes mellitus and insulinoma, of hypoglycaemia as documented by repeated continuous glucose
in which the insulinoma was treated with EUS-guided RFA. monitoring, which showed persistent hyperglycaemia with h'stix
[range of 15-16 mmol/L], without any hypoglycaemic episodes. He
was subsequently stabilized on prolonged release metformin 1g
Methods: with dinner and 2 doses of premixed insulin.

We describe a Chinese patient who had co-existing insulinoma and
type 2 diabetes mellitus diagnosed simultaneously. Both conditions Conclusion:
presented incidentally in his pre-clinic blood tests during routine
follow-up for coronary artery disease, with a raised glycated Co-existing insulinoma and diabetes mellitus can create diagnostic
haemoglobin (HbA1c) of 7.1% and a low fasting glucose level challenges that require clinical vigilance and thorough investigation
of 3 mmol/L. Further history revealed recurrent hypoglycaemic in suspicious cases. While surgery is the recommended first-line
symptoms for 3 years. Continuous glucose monitoring showed treatment, EUS-guided RFA provides a less invasive alternative to
recurrent fasting hypoglycaemia and significant post-prandial treat the tumour and to eliminate hypoglycaemia.
glucose excursions. Endogenous hyperinsulinemic hypoglycaemia

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