Insulinoma in Pregnancy Presenting with Recurrent Hypoglycemia: Diagnostic Challenges, Multidisciplinary Management, and Therapeutic Dilemmas
https://doi.org/10.15605/jafes.041.S1
- Author:
Abdullah Faiz Zaihan
1
;
Srinivas Siwalinggam
2
;
Noor Hayatul Al Akmal Noralam
3
;
Kaeshaelya Thiruchelvam
4
;
Chia Siang Kow
4
Author Information
1. Department of Pharmacy, Hospital Shah Alam
2. Department of Radiology, Hospital Shah Alam
3. Department of Radiology, Hospital Sultan Abdul Aziz Shah
4. Faculty of Pharmacy, IMU University
- Publication Type:Journal Article
- MeSH:
Female;
Pregnancy;
Insulinoma;
Hypoglycemia
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):82-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Insulinoma during pregnancy is exceedingly rare, with
fewer than 30 cases reported worldwide. Diagnosis is often
delayed due to overlapping physiological and gestational
symptoms, posing significant risks to both mother and fetus.
Case:We report a case of a 36-year-old G4P2 + 1 female presenting
at 7 weeks’ gestation with recurrent symptomatic hypoglycemia initially suspected due to poor oral intake. She
returned at 12 weeks with persistent neuroglycopenic
symptoms and weight loss. Biochemical evaluation
demonstrated inappropriately non-suppressed insulin and
C-peptide levels during hypoglycemia, raising suspicion
for endogenous hyperinsulinemia. Imaging with magnetic
resonance imaging identified a 2.3 × 2.5 cm pancreatic
lesion consistent with insulinoma.
A multidisciplinary team (MDT) approach involving
Internal Medicine, Endocrinology, Obstetrics and Gynecology (Maternal-Fetal Medicine), Hepatobiliary Surgery, and
Radiology guided management. Due to concerns regarding surgical and ablative risks during pregnancy, medical
therapy with octreotide was initiated, achieving partial
glycemic control. The pregnancy was complicated by fetal
growth restriction, necessitating delivery at 34 weeks.
Postpartum, the patient underwent endoscopic ultrasoundguided radiofrequency ablation (EUS-RFA), requiring two
sessions before achieving glycemic stabilization.
Conclusion:This case highlights the diagnostic challenges of insulinoma
in pregnancy and underscores the importance of MDTguided individualized management. It also illustrates the
limitations of EUS-RFA and medical therapy, particularly
in larger tumors, and raises important considerations
regarding fetal outcomes.
- Full text:2026080414034852476EP_A114.pdf
