1. A CASE OF RECURRENT HYPOGLYCEMIA
Sarathchandran , Harikrishnan Gangadharan, Radha
Department of General Medicine, Government Medical College, Kottayam
INTRODUCTION
insulinoma as first presentation of MEN 1 in only
10% of total cases.
We present the case of an young boy, who
presented with recurrent symptomatic
hypoglycemia as first symptom and on evaluation
was diagnosed to have INSULINOMA and ?MEN.
CASE DETAILS
• 19 year old male
• Recurrent symptomatic hypoglycemic episode
during fasting since last 1 year. Increased
frequency of symptoms since last 1 month.
• No history of seizure, abdominal pain,
polydipsia , polyphagia , or drug intake.
• He was Kept on fasting – developed
hypoglycemia Whipple triad was positive
0/E :
No PICCLE
SYSTEMS – with in normal limits
INVESTIGATIONS
● Ca – 10.48 , i PTH – 94.57
● S. INSULIN - , S- C PEPTIDE -
● MRI-
● EUS- Isoechoic rounded lesion in body of
pancreas(8.4*8.6)
● HPR- well differentiated neoplasm showing
nested growth pattern , no atypia
MIBI – negative
ACTH PROLACTIN
CLINICAL DIAGNOSIS
Pancreatic neuroendocrine tumor –insulinoma
Hyperparathyroidism - ? MEN 1
hypercalcemia
TREATMENT
Laproscopic enucleation of pancreatic tumor
Cinacalcet
Good clinical recovery after procedure
DISCUSSION
● NPSLE can have broad range of CNS or PNS
manifestations.(Occurs in 14-70 % of SLE patients)
● Chorea is extremely rare (0.9%)
● Neuropsychiatric events may precede, occur
concomitantly with, or follow diagnosis of SLE.
● No biomarkers or diagnostic tests are specific.
● Diagnosis of NPSLE almost always requires vigorous
exclusion of other causes.
● Pathogenesis can be Ischemic or Inflammatory.
● Treatment includes Immunosuppressants for
inflammatory pathology, antiplatelets and
anticoagulants for ischemic/thrombotic pathologies
CONCLUSION
SLE and APLA syndrome should be suspected in any
patient with movement disorder
Hemichorea could be the first and only presenting
symptom of SLE
