Pancreatic insulinoma combined with glucagon positive cell: A case report

Table 1 Blood test findings on admission

Albumin, g/dL	3.0 (3.9-4.9)
Total bilirubin, mg/dL	0.3 (0.2-1.0)
Aspartate aminotransferase, IU/L	7 (10-40)
Alanine aminotransferase, IU/L	7 (5-45)
Blood urea nitrogen, mg/dL	54 (7.2-20.0)
Creatinine, mg/dL	8.2 (0.5-1.1)
Sodium, mmol/L	131 (136-145)
Potassium, mmol/L	4.1 (3.6-4.8)
Chlorine, mmol/L	101 (99-109)
White blood cell, μL	8000 (3100-9500)
Hemoglobin, g/dL	9.9 (13.5-16.9)
Platelet /μL	23.6 × 104 (15.1-34.9)
Fasting blood sugar, mg/dL	290 (70-109)
Hemoglobin A1c	7.6% (4.3%-5.8%)
Insulin, μIU/mL	4860 (1.8-12.2)
C-peptide, ng/mL	14.87 (0.61-2.09)
Binding rate of anti-insulin antibodies	76.2% (< 0.4%)
Carcinoembryonic, ng/mL	7.8 (< 5.0)
Pancreatic cancer-associated antigen-2, U/mL	190 (< 150)

Renal function test results and fasting blood glucose level before starting dialysis. Values in parentheses are normal ranges in our institution. All data were collected during the fasting state.

Table 2 Changes of three parameters around distal pancreatectomy

	Before the operation	After the operation (POD 14)
Serum insulin level (1.8-12.2 μIU/mL)	4860	553
Serum C-peptide level (0.61-2.09 ng/mL)	14.87	5.28
Binding rate of anti-insulin antibodies (< 0.4%)	76.2	70.3

Values in parentheses are normal ranges in our institution. POD: Postoperative day.

Table 3 Reports of coexistent cases of pancreatic insulinoma and glucagonoma in Japan

Case	Age (yr)	Gender	Chief compliant	Definitive diagnostic procedure	Preoperative diagnosis	Operative procedure	Postoperative diagnosis
1[18]	24	M	Consciousness disturbance	ASVS + AG	Six insulinoma at pancreatic tail	DP	Five insulinomas and two glucagonomas
2[19]	73	F	Consciousness disturbance	ASVS	One insulinoma at the region of GDA perfusion	enucleation	One insulinoma and one glucagonoma
3[20]	21	M	Consciousness disturbance	ASVS	One insulinoma at the region of SpA perfusion	1st enucleation, 2nd DP	One insulinoma and one glucagonoma
4[21]	60	F	Consciousness disturbance	AG	One insulinoma at pancreatic tail	DP	One insulinoma and one glucagonoma
5[22]	59	F	Consciousness disturbance	CT	One insulinoma at pancreatic tail	DP	One insulinoma and one glucagonoma
6 (our case)	70	M	Fasting hypoglycemia	CT + EUS	One insulinoma at pancreatic tail	DP	One insulinoma and one glucagonoma

ASVS: Arterial stimulation and venous sampling; AG: Angiography; CT: Computed tomography; EUS: Endoscopic ultrasound; GDA: Gastroduodenal artery; SpA: Splenic artery; DP: Distal pancreatectomy; M: Male; F: Female.