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An insulinoma presenting with hypochondriac delusions and food refusal

  • Susana Renca (a1), Graça Santos (a1) and Joaquim Cerejeira (a1)


The authors report a case of a 68-year-old man with an unrecognized insulinoma manifesting with neuropsychiatric symptoms.

For two years, he presented with unspecified behavior changes, autonomic and neuroglycopenic symptoms, which led him to be misdiagnosed with a neurologic and psychiatric disorder before the insulinoma was recognized.

Following neurological alterations in context of hypoglycemia, subsequent to longstanding food refusal, he was admitted in the psychiatric ward. Despite good global response and normal food intake, hypoglycemic episodes were still occurring and led to a careful evaluation which permitted the definitive diagnostic.

This case highlights the diagnostic difficulties of medical disorders presenting with clinical features overlapping neurological and psychiatric syndromes. It also reflects the diagnostic difficulties in rare clinical entities, particularly in patients previously followed in psychiatry and underlines the need for a constant dialogue and updating of clinicians.


Corresponding author

Correspondence should be addressed to: Susana Renca, MD, Serviço de Psiquiatria, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal. Phone: +351-964288164; Fax: +351-239823097. Email:


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Alemdar, M., Iseri, P. and Komsuoglu, S. S. (2006). Insulinoma in differential diagnosis of seizure disorder. The Journal of Neuropsychiatry and Clinical Neurosciences, 18, 247248.
Ding, al. (2010). Neuropsychiatric profiles of patients with insulinomas. European Neurology, 63, 4851.
Dizon, A. M., Kowalyk, S. and Hoogwerf, B. J. (1999). Neuroglycopenic and other symptoms in patients with insulinomas. The American Journal of Medicine, 106, 307310.
Harrington, M. G., McGeorge, A. P., Ballantyne, J. P. and Beastall, G. (1983). A prospective survey for insulinomas in a neurology department. The Lancet, 1, 10941095.
Mathur, A., Gorden, P. and Libutti, S. K. (2009). Insulinoma. Surgical Clinics North America, 89, 11051121.
McCrimmon, R. J. (2012). Update in the CNS response to hypoglycemia. The Journal of Clinical Endocrinology and Metabolism, 97, 18.
Service, F. J. (1999). Diagnostic approach to adults with hypoglycemic disorders. Endocrinology and Metabolism Clinics of North America, 28, 519532.
Service, F. J., McMahon, M., O’ Brien, P. C. and Ballard, D. J. (1991). Functioning insulinoma – incidence, recurrence, and long-term survival of patients: a 60-year study. Mayo Clinic Proceedings,. 66, 711719.
Vig, S., Lewis, M., Foster, K. J. and Stacey-Clear, A. (2001). Lessons to be learned: a case study approach insulinoma presenting as a change in personality. The Journal of the Royal Society for the Promotion of Health, 121, 5661.



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