A Case with an 11-year History of Insulinoma, Marked Obesity, and Cerebral Atrophy

Abstract

A 43-year-old female was admitted to this Department of Medicine in 1985 with suspected insulinoma. In 1974, at the age of 31 years, she had experienced an episode of unconsciousness during the third month of pregnancy, and laboratory data at that time suggested a diagnosis of insulinoma. Selective angiography however, demonstrated no mass lesion. This patient had been hospitalized with dementia, by the Department of Neuropsychiatry and the repeated consumption of carbohydrates to prevent hypoglycemic attacks, had resulted in marked obesity, (+83% by Jones' method). In 1985, a series of laboratory tests, including repeatedly determined plasma glucose and insulin levels, glucagon testing, fasting tests, selective angiography, abdominal ultrasonography, and percutaneous transhepatic portal vein catheterization, suggested the presence of a functioning insulinoma in the body of the pancreas. Subsequently, a globular tumor of 12mm in diameter was removed successfully, and this resulted in an almost perfect correction of obesity in approximately 6 months. Computerized tomography (CT) of the patient's brain revealed considerable atrophy mainly in the cerebral cortex ; finding which has been rarely documented in the literature.