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An insulinoma presenting with hypochondriac delusions and food refusal

Published online by Cambridge University Press:  09 July 2013

Susana Renca*
Affiliation:
Centro Hospitalar e Universitário de Coimbra, EPE, Av. Bissaya Barreto – Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal
Graça Santos
Affiliation:
Centro Hospitalar e Universitário de Coimbra, EPE, Av. Bissaya Barreto – Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal
Joaquim Cerejeira
Affiliation:
Centro Hospitalar e Universitário de Coimbra, EPE, Av. Bissaya Barreto – Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal
*
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: susana.renca@gmail.com.

Abstract

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.

Type
Case Report
Copyright
Copyright © International Psychogeriatric Association 2013 

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