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An insulinoma presenting with hypochondriac delusions and food refusal

Published online by Cambridge University Press:  09 July 2013

Susana Renca ,
Graça Santos  and
Joaquim Cerejeira
Susana Renca*
Affiliation:
Centro Hospitalar e Universitário de Coimbra, EPE, Av. Bissaya Barreto – Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal
Graça Santos
Affiliation:
Centro Hospitalar e Universitário de Coimbra, EPE, Av. Bissaya Barreto – Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal
Joaquim Cerejeira
Affiliation:
Centro Hospitalar e Universitário de Coimbra, EPE, Av. Bissaya Barreto – Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal
*
Correspondence should be addressed to: Susana Renca, MD, Serviço de Psiquiatria, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal. Phone: +351-964288164; Fax: +351-239823097. Email: [email protected].
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Abstract

The authors report a case of a 68-year-old man with an unrecognized insulinoma manifesting with neuropsychiatric symptoms.

For two years, he presented with unspecified behavior changes, autonomic and neuroglycopenic symptoms, which led him to be misdiagnosed with a neurologic and psychiatric disorder before the insulinoma was recognized.

Following neurological alterations in context of hypoglycemia, subsequent to longstanding food refusal, he was admitted in the psychiatric ward. Despite good global response and normal food intake, hypoglycemic episodes were still occurring and led to a careful evaluation which permitted the definitive diagnostic.

This case highlights the diagnostic difficulties of medical disorders presenting with clinical features overlapping neurological and psychiatric syndromes. It also reflects the diagnostic difficulties in rare clinical entities, particularly in patients previously followed in psychiatry and underlines the need for a constant dialogue and updating of clinicians.

Keywords

endocrinologyoncological disordersphysical illnessneuropsychiatry
Type
Case Report
Information
International Psychogeriatrics , Volume 25 , Issue 11 , November 2013 , pp. 1909 - 1911
Copyright
Copyright © International Psychogeriatric Association 2013 

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References

Alemdar, M., Iseri, P. and Komsuoglu, S. S. (2006). Insulinoma in differential diagnosis of seizure disorder. The Journal of Neuropsychiatry and Clinical Neurosciences, 18, 247–248.Google ScholarPubMed
Ding, Y.et al. (2010). Neuropsychiatric profiles of patients with insulinomas. European Neurology, 63, 48–51.CrossRefGoogle ScholarPubMed
Dizon, A. M., Kowalyk, S. and Hoogwerf, B. J. (1999). Neuroglycopenic and other symptoms in patients with insulinomas. The American Journal of Medicine, 106, 307–310.CrossRefGoogle ScholarPubMed
Harrington, M. G., McGeorge, A. P., Ballantyne, J. P. and Beastall, G. (1983). A prospective survey for insulinomas in a neurology department. The Lancet, 1, 1094–1095.CrossRefGoogle Scholar
Mathur, A., Gorden, P. and Libutti, S. K. (2009). Insulinoma. Surgical Clinics North America, 89, 1105–1121.CrossRefGoogle ScholarPubMed
McCrimmon, R. J. (2012). Update in the CNS response to hypoglycemia. The Journal of Clinical Endocrinology and Metabolism, 97, 1–8.CrossRefGoogle ScholarPubMed
Service, F. J. (1999). Diagnostic approach to adults with hypoglycemic disorders. Endocrinology and Metabolism Clinics of North America, 28, 519–532.CrossRefGoogle ScholarPubMed
Service, F. J., McMahon, M., O’ Brien, P. C. and Ballard, D. J. (1991). Functioning insulinoma – incidence, recurrence, and long-term survival of patients: a 60-year study. Mayo Clinic Proceedings,. 66, 711–719.CrossRefGoogle ScholarPubMed
Vig, S., Lewis, M., Foster, K. J. and Stacey-Clear, A. (2001). Lessons to be learned: a case study approach insulinoma presenting as a change in personality. The Journal of the Royal Society for the Promotion of Health, 121, 56–61.CrossRefGoogle Scholar