MALIGNANT INSULINOMA WITH EXTENSIVE LIVER METASTASES PRESENTING AS DISTURBANCE OF CONSCIOUSNESS

A 56-year-old man was referred to our hospital for evaluation of episo dic disturbance of consciousness. Hypoglycemic symptoms were noted and Whipple's triad was satisfied. The 75 g OGTT and the glucagon test re vealed a high baseline insulin level and hyperreactivity to glucagon, A pancreatic tumor and liver metastases were found by abdominal comput ed tomography (CT), Based on the finding of liver biopsy, the final di agnosis was malignant insulinoma with liver metastasis, He selected co nservative treatment and no hypoglycemic crisis has occurred for one y ear since discharge. Early diagnosis and long-term follow-up is necess ary since this tumor is slow growing.