# Atypical Presentation of Insulinoma in a Patient With Hypoglycemia Unawareness: A Case Report

## TL;DR

A 69-year-old man with no symptoms of low blood sugar was diagnosed with an insulinoma after a car accident revealed dangerously low glucose levels.

## Contribution

This case highlights the atypical presentation of insulinoma in a patient with hypoglycemia unawareness.

## Key findings

- The patient had abnormally high C-peptide and insulin levels during a 72-hour fast.
- A CT scan identified a 1.25 cm pancreatic lesion consistent with insulinoma.
- The patient underwent a successful Whipple procedure and recovered well.

## Abstract

Insulinomas are uncommon tumors in the pancreas that result in the overproduction of insulin, which can cause frequent episodes of low blood sugar. While most patients present with typical symptoms such as confusion and diaphoresis, some may experience hypoglycemia unawareness. This occurs when repeated episodes of low blood glucose impair the body’s autonomic responses, making it difficult for the patient to recognize early signs of impending hypoglycemia. As a result, diagnosis can be delayed, increasing the risk of severe complications such as seizures, coma, or accidents. We present the case of a 69-year-old male diagnosed with insulinoma after a motor vehicle accident, which revealed a dangerously low blood glucose level of 2.8 mmol/L, despite the patient reporting no symptoms. Further investigations, including a supervised 72-hour fast, showed abnormally high C-peptide (1,350 pmol/L) and insulin (14 mU/L) levels, with a lab glucose reading of 2.2 mmol/L. A CT scan of the pancreas revealed a 1.25 cm enhancing lesion in the proximal body, consistent with an insulinoma. The patient underwent a successful Whipple procedure, and his postoperative recovery was uneventful. This case highlights the diagnostic challenges of insulinomas, especially in patients with hypoglycemia unawareness. It underscores the importance of considering insulinoma in the differential diagnosis of patients presenting with hypoglycemia unawareness. Early recognition and intervention are crucial to prevent serious complications associated with this condition.