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A case

Case
• Mrs ABC, 46-years-old man
• Resident of Imphal, Manipur
• Chief complaints
– Recurrent episodes of Dizziness x 7-8 months
– Recurrent episodes of sweating
– Associated with blurred vision and diarrhoea
– For these complaints, she was admitted at local
hospital and improved after intravenous fluids
(Patients was told to have low sugar level)
Case
• No h/o loss of consciousness, fall, seizure, any
neurological deficits
• No significant h/o loss or gain of weight
• Past history:
– No h/o diabetes, hypertension or any other
comorbidity
Case
• Family history:
– History of similar history in the elder brother, died
10 years prior
• Personal history:
– Nothing significant
Examination
• GPE:
– Obese lady
– Afebrile, Pulse 80/min, BP 122/78 mmHg
– No pallor, icterus, cyanosis, clubbing, oedema
• Abdominal examination:
– Normal
Blood investigations
Parameters Critical sample 1 Critical sample 2 Critical sample 3

Blood sugar 41 40 45
(mg/dL)

S. Insulin (IU/L) 17.18 19.48 16.33

S. C-peptide (IU/L) 4.49 4.92 4.66

• Hemogram, LFT, RFT: WNL


DPCT scan

Arterial and venous phase


Further investigations
• MRI with contrast: NAD
• EUS: WNL
• DOTANOC PET: NAD
• Exendin PET: NAD