IMAGING IN THE INITIAL DIAGNOSIS OF PANCREATIC INSULINOMA.

Insulinoma is the most common functional neuroendocrine tumor that originates from the islet of beta cells [1]. Advances of various diagnostic imaging methods have dramatically increased our ability to detect pancreatic diseases [2]. In particular, the ultrasonography plays an important role in the screening of pancreatic ailments [3]. Due to the small dimension of the mass, the clinicians face difficulties in diagnosing it. We present the case of a 69 years old patient diagnosed with pancreatic insulinoma which underwent imagistic examination. The patient known with hypertension and non-alcoholic steatohepatitis presented in the clinic for syncopes, sweating, anxiety and severe wight-loss. In the patient medical history, we found an emergency admission one month earlier for episodes of loss of consciousness, tremor of the upper limbs, sweating and disorientation in time and space. Abdominal ultrasonography and computed tomography showed a heterogenous 1,4 cm tumour localized in the pancreatic body with features of insulinoma. The prolonged supervised fast test that was applied induced hypoglycaemic symptoms. The level of glucose and insulin was at the lower range of the fast test. The presence of tumor was confirmed by endoscopic ultrasound, but the cytopathologic examination suggested an aspect of chronic pancreatitis. Through imaging methods and with an evocative clinical portrayal, we identified the pancreatic tumor as being an insulinoma. Even though cytology didn't support the diagnosis, we tend to believe that a false negative result cannot be ruled out. We underline the need of other specific tests in this situation. [ABSTRACT FROM AUTHOR]