# A Rare Case of Malignant Insulinoma Associated With Gastrointestinal Bleed

## TL;DR

This paper reports a rare case of a cancerous insulinoma causing both low blood sugar and gastrointestinal bleeding in an elderly patient.

## Contribution

The novelty lies in documenting a rare clinical scenario of metastatic insulinoma associated with gastrointestinal bleed.

## Key findings

- The patient presented with hypoglycemia, melena, and anemia due to a gastric mass.
- CT imaging identified a left paraaortic/retroperitoneal mass associated with the condition.
- The patient was not a surgical candidate, and treatment was ceased by the family.

## Abstract

A gastrointestinal bleed (GIB) in the setting of metastatic insulinoma is a rare phenomenon. It appears that cases of metastatic insulinoma causing GIB are rare, often influenced by the tumor's location. Our case involves an 82-year-old male with dementia and a history of recurrent hypoglycemia, presenting with an episode of altered mental status. The patient exhibited hypoglycemia alongside a melena episode and anemia. Diagnostic criteria, including Whipple’s triad, confirmed endogenous insulin production. Computed tomography (CT) showed a left paraaortic/retroperitoneal mass. Esophagogastroduodenoscopy (EGD) visualized an extrinsic mass at the gastric body, which caused an ulcerated surface that was treated with clipping and hemostasis. The patient’s recurrent hypoglycemic episodes were treated with glucose, while his GIB was managed with hemostasis and clipping. However, the patient was not a surgical candidate, and further medical treatment was ceased by the family.