Acanthosis nigricans in insulinoma: before and after successful surgical enucleation

Description

A 14-year-old girl without diabetes presented with recurrent attacks of generalised tonic–clonic seizures for the past 3 years which had partially been controlled with phenytoin and not with sodium valproate or levetiracetam. A detailed history revealed that each of those episodes was probably related to recurrent spontaneous hypoglycaemia. She was severely obese (body mass index: 36.54 kg/m²) with acanthosis nigricans (AN), facial acne and hirsutism (figure 1). During her hospital stay she developed spontaneous hypoglycaemia (plasma glucose: 25 mg/dL) and biochemical evaluation of the critical sample documented hyperinsulinaemic hypoglycaemia (serum insulin: 16.8 (>3 µIU/mL); C peptide: 3.46 (>0.6 ng/mL); β-hydroxybutyrate: 0.01 (<2.7 mmol/L)). The triphasic CT scan of abdomen revealed a 31x29 mm mass in the neck of the pancreas (figure 2). Screening for other components of multiple endocrine neoplasia type 1 (MEN-1) syndrome was negative. She underwent enucleation of the pancreatic mass and the histopathology was consistent with insulinoma....

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