Intractable hypoglycemia in pregnancy

Kavita Peter Gonsalves, Mallikarjun V. J., Annamma Thomas, Ganapathi Bantwal


Insulinomas are rare tumours developed from pancreatic beta cells; 27 cases of insulinoma associated with pregnancy have been reported till date, mostly diagnosed before the 16th week. Triad of insulinoma; hypoglycemic symptoms, plasma glucose < 3.0 mmol/L, symptomatic relief with glucose administration. 28-year-old primi presented to us at 29 weeks with high BP and neuroglycopenic symptoms. Repeated episodes of loss of consciousness with hypoglycemia since 14 weeks. On evaluation diagnosed to have insulinoma and managed conservatively with dietary modifications, and medical treatment. She failed to respond and pregnancy was terminated due to high BP, hypoglycemia and Doppler changes. Delivered a stillborn girl at 31 weeks. Underwent laparotomy post-delivery for enucleation of the lesion. Quick normalization of sugar levels and overall recovery remarkable. Patient is on regular follow up. Insulinoma is a rare cause of severe repeated episodes of hypoglycemia early in pregnancy.


Hypoglycemia, Insulinoma

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Melmed S, Polonsky SK, Larsen RP, Kronerberg MH. Williams Text Book of Endocrinology, 12th Edition. Elsevier Saunders; 2011.

Chakradhar K, Sisodiya RR, Prabhu M, Maru R. A rare presentation of insulinoma as postpartum hypoglycaemia. World J Surg Res. 2014;3:1-5.

Rodrigues Queiroz AJ, Nazareno LS, Miranda JE, de Azevedo AE, Teixeira da Cruz CA, Pirani Carneiro F et al. Insulinoma diagnosed in the postpartum: clinical and immunohistochemical features. Gynecol Endocrinol. 2012;28(8):633-6.

Lansdown A, Rees DA. Endocrine oncology in pregnancy. Best Pract Res Clin Endocrine Metab. 2011;25(6):911-26.

Vezzosi D, Bennet A, Maiza JC, Buffet A, Grunenwald S, Fauvel J et al. Diagnosis and treatment of insulinomas in the adults. In Basic and Clinical Endocrinology Up-to-Date. book edited by Fulya Akin. Intech Publisher; 2011:135-176.

Diaz AG, Herrera J, López M, Félix M. Puchulu, Pedro Ferraina, Oscar D. Bruno. Insulinoma associated with pregnancy. Fertil Steril. 2008;90(1):199e1-4.