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Insulinoma and Gastrinoma Syndromes from a Single Intrapancreatic Neuroendocrine Tumor

National Institute of Child Health and Human Development (M.B.L.); Surgery Branch (A.C.P., S.K.L., J.F.P.) and Laboratory of Pathology (M.A.-A., P.L., M.T.), National Cancer Institute; and Clinical Endocrinology Branch (C.C., P.G.), Division of Intramural Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892

Address all correspondence and requests for reprints to: Phillip Gorden, 10 Center Drive, CRC Room 6-5940, Bethesda, Maryland 20892. E-mail: PhillipG{at}intra.niddk.nih.gov.

Context: The insulinoma syndrome is marked by fasting hypoglycemia and inappropriate elevations of insulin. The gastrinoma syndrome is characterized by hypergastrinemia, ulcer disease, and/or diarrhea. Rarely, insulinoma and gastrinoma coexist in the same patient simultaneously.

Objective: Our objective was to determine the cause of a patient’s hypoglycemic episodes and peptic ulcer disease.

Design and Setting: This is a clinical case report from the Clinical Research Center of the National Institutes of Health.

Patient and Intervention: One patient with hypoglycemic episodes and peptic ulcer disease had a surgical resection of neuroendocrine tumor.

Results: The patient was found to have a single tumor cosecreting both insulin and gastrin. Resection of this single tumor was curative.

Conclusions: A single pancreatic neuroendocrine tumor may lead to the expression of both the hyperinsulinemic and hypergastrinemic syndromes.