{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T10:45:52Z","timestamp":1763117152699,"version":"3.45.0"},"reference-count":10,"publisher":"Grigore T. Popa University of Medicine and Pharmacy","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arch Clin Cases"],"abstract":"<jats:p>Insulinoma is a rare functional neuroendocrine tumor of pancreatic islet cells that produces excessive insulin leading to neuroglycopenic and autonomic symptoms relieved by glucose. We report a case of a 39-year-old woman with recurrent neuroglycopenic symptoms for nearly five years, initially misdiagnosed as migraine, until she presented to ED with a collapse secondary to hypoglycemia. Biochemical confirmation was obtained during a supervised 72-hour fast, with symptomatic hypoglycemia which showed lowest glucose levels of 1.7mmol\/L, elevated C-peptide levels of 2,271pmol\/L, high insulin levels of 83.5 mU\/L and a negative sulfonylurea screen. Imagining demonstrated a large hyper enhancing pancreatic mass, confirmed by \u2076\u2078Ga-DOTATATE PET as a solitary lesion without metastasis. Histopathology revealed a well-differentiated Grade 1 neuroendocrine tumor measuring 90\u00d765\u00d740 mm. Following surgical intervention, she demonstrated a successful recovery. This case emphasizes the need to consider insulinoma early in the differential diagnosis of recurrent neuroglycopenic episodes to prevent serious complications and avoid inappropriate treatments.<\/jats:p>","DOI":"10.22551\/2025.48.1203.10325","type":"journal-article","created":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T10:40:57Z","timestamp":1763116857000},"page":"127-131","source":"Crossref","is-referenced-by-count":0,"title":["Insulinoma initially misdiagnosed as migraine"],"prefix":"10.22551","volume":"12","author":[{"name":"Department of Acute Medicine, Queen\u2019s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Javeria","family":"Hameed","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irbaz","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Department of Accident and Emergency, Queen\u2019s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3351-6460","authenticated-orcid":false,"given":"Abed M.","family":"Zaitoun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Department of Cellular Pathology, Queen\u2019s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK; Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen\u2019s Medical Centre, Nottingham, UK","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"9837","published-online":{"date-parts":[[2025,9,22]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"\"1. Kelash F, Mulinda J. Insulinoma: A rare cause of hypoglycemia in a young female. J Community Hosp Intern Med Perspect. 2014 Sep 29;4(4). doi: 10.3402\/jchimp.v4.25093. PMID: 25317264; PMCID: PMC4185142.","DOI":"10.3402\/jchimp.v4.25093"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"2. Marini F, Giusti F, Brandi ML. Genetic disorders and insulinoma\/glucagonoma. Endocr Relat Cancer. 2024 Apr 16;31(5):e230245. doi: 10.1530\/ERC-23-0245. PMID: 38552306.","DOI":"10.1530\/ERC-23-0245"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"3. Taye A, Libutti S. Diagnosis and management of insulinoma: current best practice and ongoing developments. Res Rep Endocr Disord. 2015;5:125-33. doi:10.2147\/RRED.S86565.","DOI":"10.2147\/RRED.S86565"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"4. Okabayashi T, Shima Y, Sumiyoshi T, et al. Diagnosis and management of insulinoma. World J Gastroenterol. 2013 Feb 14;19(6):829-37. doi: 10.3748\/wjg.v19.i6.829. PMID: 23430217; PMCID: PMC3574879.","DOI":"10.3748\/wjg.v19.i6.829"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"5. Mahaldar EA, Khan K, Khan M, Shahbuddin MI. Insulinoma: Unraveling the Mystery of a Stealthy Culprit. Cureus. 2024 Nov 24;16(11):e74364. doi: 10.7759\/cureus.74364. PMID: 39723310; PMCID: PMC11669375.","DOI":"10.7759\/cureus.74364"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"6. Gozzi Graf T, Br\u00e4ndle M, Clerici T, l'Allemand D. Insulinoma: only in adults?-case reports and literature review. Eur J Pediatr. 2014 May;173(5):567-74. doi: 10.1007\/s00431-013-2005-8. PMID: 23604412.","DOI":"10.1007\/s00431-013-2005-8"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"7. Marini F, Falchetti A, Del Monte F, et al. Multiple endocrine neoplasia type 1. Orphanet J Rare Dis. 2006 Oct 2;1:38. doi: 10.1186\/1750-1172-1-38. PMID: 17014705; PMCID: PMC1594566.","DOI":"10.1186\/1750-1172-1-38"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"8. Nockel P, Babic B, Millo C, et al. Localization of Insulinoma Using 68Ga-DOTATATE PET\/CT Scan. J Clin Endocrinol Metab. 2017 Jan 1;102(1):195-199. doi: 10.1210\/jc.2016-3445. PMID: 27805844; PMCID: PMC6083884.","DOI":"10.1210\/jc.2016-3445"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"9. Tarris G, Rouland A, Guillen K, et al. Case Report: Giant insulinoma, a very rare tumor causing hypoglycemia. Front Endocrinol (Lausanne). 2023 May 10;14:1125772. doi: 10.3389\/fendo.2023.1125772. PMID: 37234805; PMCID: PMC10206132.","DOI":"10.3389\/fendo.2023.1125772"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"10. Zhao YP, Zhan HX, Zhang TP, et al. Surgical management of patients with insulinomas: Result of 292 cases in a single institution. J Surg Oncol. 2011 Feb;103(2):169-74. doi: 10.1002\/jso.21773. PMID: 21259252.\"","DOI":"10.1002\/jso.21773"}],"container-title":["Archive of Clinical Cases"],"original-title":[],"link":[{"URL":"https:\/\/clinicalcases.eu\/index.php\/acc\/article\/view\/1194\/359","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T10:41:51Z","timestamp":1763116911000},"score":1,"resource":{"primary":{"URL":"https:\/\/clinicalcases.eu\/index.php\/acc\/article\/view\/1194"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,22]]},"references-count":10,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,9,22]]}},"URL":"https:\/\/doi.org\/10.22551\/2025.48.1203.10325","relation":{},"ISSN":["2360-6975","2360-6975"],"issn-type":[{"value":"2360-6975","type":"print"},{"value":"2360-6975","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,22]]}}}