INSULINOMA PRESENTING ITSELF AS A NIGHT PAROXYSMAL DISORDER WITH SPONTANEOUS RECOVERY
Autori:
Leja Dolenc Grošelj, Dušan Butinar
Sažetak
Sažetak. U radu je opisana 64-godišnja žena s epizodama paroksizama tijekom noći. Simptomi su započeli prije 9 mjeseci s atakama bizarnih pokreta, koje su se uvijek javljale u drugom dijelu noći. tijekom dana nije imala atake. Njezin suprug navodi da je bila konfuzna i dezorijentirana, nakon čega je slijedilo duže razdoblje nereagiranja. Pacijentici je učinjena noćna polisomnografija. Oko 4 sata ujutro pojavili su se bizarni pokreti uz stereotipno ponašanje. Vrtjela je glavom s jedne na drugu stranu, stenjala i istezala udove. Ovo je isprva trajalo nekoliko minuta, a tijekom noći stalno se ponavljalo. EEG nalaz je upućivao na metaboličku encefalopatiju. U to je vrijeme u krvi iz prsta nađena izrazita hipoglikemija (1,2 mmol/l), visok inzulin (200 mmol/l) i C-peptid (6,63 µmol/l). Ultrasonografija i MEI potvrdile su inzulinom u glavi pankreasa. Prema našim saznanjima ovo je prvi slučaj ataka inzulinom tijekom spavanja.
Summary
Summary. A 64-year-old woman with night paroxysmal episodes is described. Her symptoms began 9 months ago with attacks of bizarre movement, which were always present in the second part of the night. She had no attacks during the daytime. Her husband reported confusion and disorientation followed by long periods of unresponsiveness. The patient underwent a night polysomnography recording. Around 4 o’clock in the morning bizarre movements with stereotypic behaviour appeared. She was rolling her head from side to side, moaning, and stretching her limbs. These periods first lasted for minutes, and were constantly repeated during the night. EEG findings suggested metabolic encephalopathy. At that time finger prick test revealed a profound hypoglycaemia (1.2 mmol/l), high insulin (200 pmol/l), and C-peptide (6.63 nmol/l). Ultrasonography and MRI confirmed the insulinoma in the head of the pancreas. To our knowledge our case is the first patient with insulinoma attacks only during sleep time.
