Recently, Mr. Zhao from Zhejiang returned to work after a minor surgery. Not long ago, however, he was misunderstood by family and colleagues as "lazy and gluttonous" due to a highly overlooked "niche" condition.
The 33-year-old Mr. Zhao had previously been in good health. Yet by late 2018, he seemed like a different person—often listless and fatigued at work. Routine examinations at his hometown's primary hospital showed no abnormalities.What baffled his colleagues and family even more was that while complaining of fatigue, his appetite grew daily and his weight rapidly increased.
One night, Mr. Zhao suddenly lost consciousness and was rushed to the hospital. His blood sugar level was only 2.2 mmol/L. He was later transferred to Zhejiang Provincial People's Hospital. "Although such patients are rare, our clinical experience allowed us to quickly diagnose an insulinoma," said the hospital's physician.
The doctor then led his team in performing minimally invasive surgery on Mr. Zhao. Using laparoscopy to access the pancreas, they successfully removed the insulinoma. He recovered fully and was discharged within a week of hospitalization.
The doctor explained that insulinomas primarily manifest with the following clinical characteristics: Young adults often present with dizziness, fatigue, and reluctance to move, leading others to mistakenly label them as lazy or gluttonous;Middle-aged individuals may experience memory loss, sometimes even forgetting their way home, leading to misdiagnosis as mental illness; elderly patients may suffer sudden fainting spells, mistaken for cardiovascular disease.
In reality, these abnormal symptoms stem from insulinoma-induced hypoglycemia, medically termed "hypoglycemia."When an insulinoma develops on the pancreas, abnormal insulin secretion occurs, causing patients to experience hunger, dizziness, fatigue, and palpitations. Severe cases may lead to coma. (Source: People's Daily Online)
Further Reading:
What are the clinical manifestations of insulinoma?
Sympathetic Nervous System Activation Manifestations
Compensatory responses to hypoglycemia, such as pallor, cold extremities, cold sweats, palpitations, trembling hands, and weak legs.
Altered Mental Status
Resulting from glucose deprivation in brain cells due to hypoglycemia, including mental confusion, drowsiness, and coma;may also present as mental confusion, slowed reactions, or cognitive decline.
Psychiatric Abnormalities
Result from repeated hypoglycemic episodes further suppressing the cerebral cortex. Symptoms vary widely; severe cases exhibit pronounced psychiatric manifestations, sometimes misdiagnosed as psychosis.
Temporal lobe epilepsy
Resembling grand mal seizures, this represents the most severe neuropsychiatric manifestation. Attacks involve loss of consciousness, clenched jaws, limb convulsions, and incontinence.
Etiology of Insulinoma
Clinical manifestations stem from elevated blood insulin levels, but more critically, insulin secretion lacks normal physiological feedback regulation—not merely excessive secretion. Under physiological conditions, normal blood glucose is maintained by insulin and glucagon.When blood glucose levels decrease, glucagon secretion increases while insulin secretion is suppressed. When blood glucose drops to 1.94 mmol/L, insulin secretion nearly ceases entirely. However, in insulinoma patients, this normal physiological feedback mechanism is completely lost. Tumor cells continue to secrete insulin unabated, leading to hypoglycemia.Brain cells primarily rely on glucose for energy metabolism and cannot efficiently utilize glycogen. Consequently, when blood glucose levels drop, brain cell metabolism is immediately affected, leading to central nervous system symptoms such as drowsiness, confusion, and even coma.