A Rare Presentation of Insulinoma as Postpartum Hypoglycaemia

Insulinomas are rare neuroendocrine tumors, being even rarer during pregnancy. Postpartum hypoglycemia is an uncommon presentation due to insulinoma. We present a case of 25 year old female who presented with complaints of sweating and drowsiness relieved by taking oral glucose. Patient had history of loss of consciousness five days after delivery. She was evaluated with necessary investigations but the cause could not be identified and hence treated symptomatically. She is suffering from similar complaints since 10 months whenever she skips a meal which were relieved by taking glucose. Patient was evaluated with supervised 72 hour fast during the present admission during which she developed neuroglycopenic symptoms after four hours of fasting, with low plasma glucose of 27mg/dl and inappropriately elevated levels of serum insulin 13.5 μU /ml. Failure of endogenous insulin secretion to be suppressed by hypoglycemia is the hallmark of an insulinoma .Magnetic resonance imaging of abdomen revealed a 1.5*1.9 cm mass in body of pancreas which was treated by enucleation with histopathology confirming insulinoma. Our case illustrates the importance of considering insulinoma as a cause of postpartum hypoglycemia