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Insulinoma in Chronic Renal Failure: A Case Report

Marshfield Clinic (M.T.S.), Wausau, Wisconsin 54401; and Division of Endocrinology (A.B., F.J.S.) and Department of Surgery (G.B.T.), Mayo Clinic, Rochester, Minnesota 55905

Address all correspondence and requests for reprints to: Ananda Basu, M.D., 5-194 Joseph, Saint Mary’s Hospital, Mayo Clinic, Rochester, Minnesota 55902. E-mail: basu.ananda{at}mayo.edu.

Abstract

The diagnosis of insulinoma depends on the fulfillment of well-established criteria during the 72-h fast. However, these criteria rely on normal renal function. Spontaneous hypoglycemia that is not attributable to insulinoma may occur in persons with renal failure. We describe herein a patient with renal impairment who had undergone renal transplant and had a 20-yr history of hypoglycemic symptoms and successful resection of insulinoma. Although the results of a 72-h fast were consistent with endogenous hyperinsulinemia, their interpretation was complicated in the presence of renal impairment. Fortunately, the identification of the tumor, by endoscopic ultrasonograph, led to a correct diagnosis. This case seems to be the second report of a patient with insulinoma with concomitant renal failure.