# Recurrent Hypoglycemia in a Non-diabetic: A Case of Suspected Insulinoma Lost to Follow-Up

## TL;DR

A non-diabetic woman experienced severe hypoglycemia and a seizure, suggesting an insulinoma, but failed to follow up for confirmation.

## Contribution

Highlights the importance of considering insulinoma in non-diabetic patients with unexplained hypoglycemia.

## Key findings

- A 56-year-old non-diabetic woman presented with hypoglycemia and seizure, suggesting insulinoma.
- Imaging identified a pancreatic lesion consistent with insulinoma, but follow-up testing was not completed.
- Emergency physicians should consider rare causes like insulinoma in cases of unexplained hypoglycemia.

## Abstract

Insulinomas are rare insulin-secreting pancreatic neuroendocrine tumors (PNETs) that can cause profound hypoglycemia, particularly in non-diabetic patients. We report the case of a 56-year-old female who presented to the emergency department with altered mental status, a witnessed seizure, and recurrent, refractory hypoglycemia. She had no history of diabetes or hypoglycemic agent use and was reportedly in her usual state of health until the event. Initial emergency evaluation revealed persistent hypoglycemia despite dextrose administration. Cross-sectional imaging identified a pancreatic lesion concerning for insulinoma in the appropriate clinical context. Although confirmatory outpatient biochemical testing (e.g., insulin, C-peptide levels) was planned, the patient was ultimately lost to follow-up. This case underscores the critical role of emergency physicians in maintaining a broad differential when evaluating unexplained, refractory hypoglycemia, particularly when formal diagnosis is precluded.