Vague behavioral and personality changes and a misdiagnosis of complex partial epilepsy
Year 2014,
Volume: 39 Issue: 4, 0 - , 22.07.2014
Qalandar Kasnazan
Osama Shukir Muhammed Amin
Karzan Seerwan
Hiwa Abu Bakir
Bakhtiar Fayak
Hiza Qalandar Hussein
Abstract
Pancreatic insulinomas are rare endocrine tumors and their diagnosis needs a high index of suspicion. Several patients receive an initial misdiagnosis before the tumor is being finally detected. We report on two patients who presented with vague and bizarre personality and behavioral changes. One patient was initially diagnosed with hysteria and both eventually were diagnosed with complex partial epilepsy. They had not improved on anti-epileptic medications and their symptomatology continued to deteriorate. Their final diagnosis turned out to be pancreatic insulinoma. Because of the rarity of insulinomas as well as their diverse and non-pathognomonic symptoms, the diagnosis remains challenging and may quite well escape detection unless it is entertained.
References
- Langerhans P. "Beitrage zur mikroscopischen anatomie der bauchspeichel druse". Inauguraldissertation. Berlin: Gustav Lange; 1869.
- Banting F, Best C. Internal secretion of pancreas. J Lab Clin Med. 1922;7:251-66.
- Harris S. Hyperinsulinism and dysinsulinism. JAMA. 1924;83:729-33.
- Wilder RM, Allan FN, Power MH, Robertson H. Carcinoma of the islets of the pancreas: hyperinsulinism and hypoglycemia. J Am Med Assoc. 1927;89:348-55.
- Welbourn RB, Barabas AP. Hormone-secreting tumors of the pancreas. Postgrad Med J. 1976;43:24
- Whipple AO, Frautz VK. Adenomas of islet cells with hyperinsulinism: a review. Ann Surg. 1935;101:12993
- Service FJ, McMahon MM, O’Brien PC, Ballard DJ. Functioning insulinoma--incidence, recurrence, and long-term survival of patients: a 60-year study. Mayo Clin Proc. 1991;66:711-9.
- Lam KY, Lo CY. Pancreatic endocrine tumour: a 22year clinico-pathological experience with morphological, immunohistochemical observation and a review of the literature. Eur J Surg Oncol. 1997;23:36-42.
- Gumbs AA, Moore PS, Falconi M, Bassi C, Beghelli S, Modlin I, Scarpa A. Review of the clinical, histological, and molecular aspects of pancreatic endocrine neoplasms. J Surg Oncol. 2002;81:45-53; discussion 54.
- Mathur A, Gorden P, Libutti SK. Insulinoma. Surg Clin North Am. 2009;89:1105-21.
- Okabayashi T, Shima Y, Sumiyoshi T, Kozuki A, Ito S, Ogawa Y, et al. Diagnosis and management of insulinoma. World J Gastroenterol. 2013;19:829-37.
- Boukhman MP, Karam JH, Shaver J, Siperstein AE, Duh QY, Clark OH. Insulinoma-experience from 1950 to 19 West J Med. 1998;169:98-104.
- Metz DC, Jensen RT. Gastrointestinal neuroendocrine tumors: pancreatic endocrine tumors. Gastroenterology. 2008;135:1469-92.
- Mahabalshetti AD, Aithal KR, Patil BS, Patil PB. Insulinoma- a misleading neuroendocrine tumour. Int J Biol Med Res. 2013;4:2975-7.
- Jagadheesan V, Suresh SS. Episodic confusional state: Due to insulinoma. Indian J Psychiatry. 2008;50:197-9.
- Halder PJ, Hafeezunnisa P, Pai R, Samsi AB. Insulinoma. J Postgrad Med. 1992;38:202-4.
- Nakamura Y, Doi R, Kohno Y, Shimono D, Kuwamura N, Inoue K, et al. High dose calcium stimulation test in a case of insulinoma masquerading as Hysteria. Endocrine. 2002;19:127-30.
- Vig S, Lewis M, Foster KJ, Stacey-Clear A. Lessons to be learned: A case study approach insulinoma presenting as a change in personality. JR Soc Health. 2001;121:56-61.
- Graves TD, Gandhi S, Smith SJ, Sisodiya SM, Conway GS. Misdiagnosis of seizures: insulinoma presenting as adult-onset seizure disorder. J Neurol Neurosurg Psychiatry. 2004;75:1091-2.
- Alemdar M, Iseri P, Komsuoglu SS. Insulinoma in differential diagnosis of seizure disorder. J Neuropsychiatry Clin Neurosci. 2006;18:247-8.
- Marney A, Jagasia S. Case study: Diagnostic dilemma in a patient with insulinoma. Clin Diab. 2007;25:152-4.
- Soh AW, Kek PC. Insulinoma in a patient with normal results from prolonged fast and glucagoninduced hypoglycemia. Endocr Pract. 2010;16:838
- Druce MR, Muthuppalaniappan VM, O'Leary B, Chew SL, Drake WM, Monson JP, et al. Diagnosis and localisation of insulinoma: the value of modern magnetic resonance imaging in conjunction with calcium stimulation catheterisation. Eur J Endocrinol. 2010;162:971-8.
- Aggarwal B, Gothi R, Aggarwal A, Doda S, Verma K. Spiral CT and MR appearances of pancreatic head insulinoma. Indian J Radiol Imaging. 2000;10:37-8
- Yazışma Adresi / Address for Correspondence: Dr. Osama Shukir Muhammed Amin Sulaimaniya Post-Office, PO BOX 196, Sulaimaniya City, Kurdistan Region, IRAQ E-mail: dr.osama.amin@gmail.com G eliş tarihi/Received on : 03.05.2014
- Kabul tarihi/Accepted on: 30.05.2014
Şüpheli Davranış ve Kişisel Değişimler ile Karışık Kısmi Epilepsinin Yanlış Teşhisi
Year 2014,
Volume: 39 Issue: 4, 0 - , 22.07.2014
Qalandar Kasnazan
Osama Shukir Muhammed Amin
Karzan Seerwan
Hiwa Abu Bakir
Bakhtiar Fayak
Hiza Qalandar Hussein
Abstract
Pankreatik insülinom nadir görülen endokrin tümörü olup teşhisi ciddi anlamda yüksek şüphe gerektirmektedir. Hastaların çoğuna son aşamada gözlenen tümör bulgusundan önce yanlış teşhis konulmaktadır. Bu raporda belirsiz ve şüpheli davranış gösteren iki hastayı ele aldık. Hastanın birine ilk olarak histeri teşhisi konmasına ragmen sonunda her ikisine birden karışık kısmi epilepsi tanısı kondu. Her ikisine anti-epileptik ilaçlar verilmesine rağmen iyileşme gözlenmedi ve belirtileri bu durum daha kötü hale gelene kadar devam etti. Son olarak pankreatik insülinom hastası oldukları ortaya çıktı. İnsülinomlar farklı ve patognomonik olmayan belirtilerinin yanı sıra nadir görülmelerinden dolayı oldukça zor teşhis edilmektedirler ve çok belirgin olmadıkça gözden kaçabilmektedirler.
References
- Langerhans P. "Beitrage zur mikroscopischen anatomie der bauchspeichel druse". Inauguraldissertation. Berlin: Gustav Lange; 1869.
- Banting F, Best C. Internal secretion of pancreas. J Lab Clin Med. 1922;7:251-66.
- Harris S. Hyperinsulinism and dysinsulinism. JAMA. 1924;83:729-33.
- Wilder RM, Allan FN, Power MH, Robertson H. Carcinoma of the islets of the pancreas: hyperinsulinism and hypoglycemia. J Am Med Assoc. 1927;89:348-55.
- Welbourn RB, Barabas AP. Hormone-secreting tumors of the pancreas. Postgrad Med J. 1976;43:24
- Whipple AO, Frautz VK. Adenomas of islet cells with hyperinsulinism: a review. Ann Surg. 1935;101:12993
- Service FJ, McMahon MM, O’Brien PC, Ballard DJ. Functioning insulinoma--incidence, recurrence, and long-term survival of patients: a 60-year study. Mayo Clin Proc. 1991;66:711-9.
- Lam KY, Lo CY. Pancreatic endocrine tumour: a 22year clinico-pathological experience with morphological, immunohistochemical observation and a review of the literature. Eur J Surg Oncol. 1997;23:36-42.
- Gumbs AA, Moore PS, Falconi M, Bassi C, Beghelli S, Modlin I, Scarpa A. Review of the clinical, histological, and molecular aspects of pancreatic endocrine neoplasms. J Surg Oncol. 2002;81:45-53; discussion 54.
- Mathur A, Gorden P, Libutti SK. Insulinoma. Surg Clin North Am. 2009;89:1105-21.
- Okabayashi T, Shima Y, Sumiyoshi T, Kozuki A, Ito S, Ogawa Y, et al. Diagnosis and management of insulinoma. World J Gastroenterol. 2013;19:829-37.
- Boukhman MP, Karam JH, Shaver J, Siperstein AE, Duh QY, Clark OH. Insulinoma-experience from 1950 to 19 West J Med. 1998;169:98-104.
- Metz DC, Jensen RT. Gastrointestinal neuroendocrine tumors: pancreatic endocrine tumors. Gastroenterology. 2008;135:1469-92.
- Mahabalshetti AD, Aithal KR, Patil BS, Patil PB. Insulinoma- a misleading neuroendocrine tumour. Int J Biol Med Res. 2013;4:2975-7.
- Jagadheesan V, Suresh SS. Episodic confusional state: Due to insulinoma. Indian J Psychiatry. 2008;50:197-9.
- Halder PJ, Hafeezunnisa P, Pai R, Samsi AB. Insulinoma. J Postgrad Med. 1992;38:202-4.
- Nakamura Y, Doi R, Kohno Y, Shimono D, Kuwamura N, Inoue K, et al. High dose calcium stimulation test in a case of insulinoma masquerading as Hysteria. Endocrine. 2002;19:127-30.
- Vig S, Lewis M, Foster KJ, Stacey-Clear A. Lessons to be learned: A case study approach insulinoma presenting as a change in personality. JR Soc Health. 2001;121:56-61.
- Graves TD, Gandhi S, Smith SJ, Sisodiya SM, Conway GS. Misdiagnosis of seizures: insulinoma presenting as adult-onset seizure disorder. J Neurol Neurosurg Psychiatry. 2004;75:1091-2.
- Alemdar M, Iseri P, Komsuoglu SS. Insulinoma in differential diagnosis of seizure disorder. J Neuropsychiatry Clin Neurosci. 2006;18:247-8.
- Marney A, Jagasia S. Case study: Diagnostic dilemma in a patient with insulinoma. Clin Diab. 2007;25:152-4.
- Soh AW, Kek PC. Insulinoma in a patient with normal results from prolonged fast and glucagoninduced hypoglycemia. Endocr Pract. 2010;16:838
- Druce MR, Muthuppalaniappan VM, O'Leary B, Chew SL, Drake WM, Monson JP, et al. Diagnosis and localisation of insulinoma: the value of modern magnetic resonance imaging in conjunction with calcium stimulation catheterisation. Eur J Endocrinol. 2010;162:971-8.
- Aggarwal B, Gothi R, Aggarwal A, Doda S, Verma K. Spiral CT and MR appearances of pancreatic head insulinoma. Indian J Radiol Imaging. 2000;10:37-8
- Yazışma Adresi / Address for Correspondence: Dr. Osama Shukir Muhammed Amin Sulaimaniya Post-Office, PO BOX 196, Sulaimaniya City, Kurdistan Region, IRAQ E-mail: dr.osama.amin@gmail.com G eliş tarihi/Received on : 03.05.2014
- Kabul tarihi/Accepted on: 30.05.2014