Case Report and Literature Review of Insulinoma in the Geriatric Population: An 86-Year-Old Female with Syncope of Unknown Origin

Table 1

Outline of the literature with insulinoma cases including characteristics of patients, image modality of choice for diagnosis, location of tumor, and treatment plan.

Literature review of insulinomas in elderly patients (above 75 years of age)
Name of study	Year	Age of presentation	Male vs. fatale	History of multiple endocrine neoplasia	Initial glucose level (mg/dL)	Glucose level within 72-hour fast trial	Imaging modality for diagnosis	Tumor size and location	Metastasis	Surgical management	Medical management
An elderly patient with an insulinoma who had prolonged dementia-like symptoms [12]	1998	77	Female	—	34 mg/dL	—	Abdominal ultrasound; mass not seen on CT or MRI; tumor localized via abdominal arteriography	1 cm tumor localized at the pancreatic tail	—	Pancreatectomy	—
Malignant insulinoma: spectrum of unusual clinical features [13]	2005	82	Female	No	26 mg/dL	—	Abdominal MRI	8.0 cm tumor localized at the dome of the liver	Yes	Percutaneous radiofrequency ablation	—
Successful treatment of insulinoma by a single daily dose of octreotide in two elderly female patients [14]	2006	76	Female	No	—	39 mg/dL after 6 hours	Abdominal angiography	1.5 cm tumor localized at the dome of the liver	No	Refused surgical management	Octreotide 50 μg subcutaneous once daily
Successful treatment of insulinoma by a single daily dose of octreotide in two elderly female patients [14]	2006	85	Female	No	61 mg/dL	37 mg/dL	Abdominal CT	1.5 cm tumor localized at the pancreatic uncus	No	Unsuitable for surgery due to obesity	Initial management was octreotide 100 μg subcutaneous once daily and subsequently reduced to octreotide 50 μg subcutaneous once daily
Pancreatic insulinoma coexisting with gastric GIST in the absence of neurofibromatosis 1 [15]	2009	76	Female	No	—	—	Abdominal CT	1.3 cm localized at the pancreatic tail	No	Pancreatectomy	Initial management with diazoxide
Insulinoma in the elderly: a report of 3 cases and review literature [11]	2014	82	Female	Yes	—	—	Abdominal MRI	Unknown size; location initially pancreas with metastasis to liver	Yes	Pancreatectomy w/partial hepatectomy (1993); radiofrequency (2004 and 2006); selective angiographic embolization (2010)	Metastasis in 2011: initial management with subcutaneous injection of octreotide 0.1 mg twice a day and switched to long-acting lanreotide 120 mg every four weeks upon discharge; further progression of metastasis in 2012; lanreotide was switched to diazoxide 100 mg three times a day w/symptomatic improvement
Insulinoma in the elderly: a report of 3 cases and review literature [11]	2014	84	Male	No	—	—	Abdominal MRI	1 cm tumor localized at pancreatic tail that progressed to 2.2 cm in size	No	Refused surgery (2006); received unsuccessful selective embolization (2012)	Octreotide 0.2 mg three times a day
Insulinoma in the elderly: a report of 3 cases and review literature [11]	2014	85	Male	No	—	—	Abdominal MRI	4 cm tumor localized at the pancreatic head	No	Refused surgical management	Initial management with subcutaneous injection of octreotide 0.1 mg twice a day and switched to long-acting lanreotide 120 mg every four weeks upon discharge
Octreotide LAR was useful for avoiding hypoglycemia in an elderly patient with insulinoma [16]	2017	80	Female	No	—	—	—	—	No	Refused surgical management	Initial management with octreotide 50 mg subcutaneous injection every day; subsequently switched to lanreotide 120 mg every 4 weeks
Insulinoma case report and literature review of insulinoma in 86-year-old female with late onset hypoglycemia of unknown origin	2020	86	Female	No	38 mg/dL	32 mg/dL	Abdominal CT	1.6 cm tumor localized at pancreatic tail	No	Pancreatectomy with enucleation	—