Approach to refractory hypoglycemia in the setting of pancreatic mass and commonly seen pitfalls

Abstract

An 86-year-old male presented with severe hypoglycemia and encephalopathy. Hypoglycemia workup determined the cause to be endogenous insulin. A pancreatic mass increased clinical suspicion for insulinoma, a rare pancreatic neuroendocrine tumor. Surgery is curative; however, the patient in this case was placed on comfort measures and died. This case report examines the clinical guidelines for evaluation, diagnosis, and management of hypoglycemia in persons without diabetic mellitus. Keywords: Hypoglycemia, testing, pancreatic mass