A Rare Case of Insulinoma in a Patient with Hydrocephalus and COVID-19

Insulinoma is a rare entity, in which neuroglycopenia symptoms of recurrent hypoglycemia are often confused with the neuropsychiatric disorder, especially in a patient with hydrocephalus. Hypoglycemia leads to a proinflammatory and procoagulant state, which may worsen the COVID-19 prognosis. We report a case of a 25-year-old woman with an initial presentation of seizure. No previous medical history and drugs were recorded. Intravenous dextrose is administered as low blood sugar was evident but no marked improvement in consciousness was observed. Later head CT scan revealed hydrocephalus and brain atrophy. While intracranial lesion was thought to be the reason, recurrent hypoglycemia was recorded despite meticulous partial parenteral nutrition. Plasma insulin and C-peptide test showed in appropriately high values in the hypoglycemic state (154.5 uIU/mL and 12.1 ng/ mL, respectively) and lead to insulinoma, which was in accordance with the MRI result. Thorough non- operative management was commenced, and blood glucose was eventually controlled. Unfortunately, the patient developed pneumonia COVID-19 and died of respiratory failure. Diagnosis of insulinoma in hydrocephalus patients with seizures and altered levels of consciousness is challenging. Non-operative management is difficult in an unconscious patient, let alone in an isolation room. Moreover, the COVID-19 prognosis is proven to be worse in hypoglycemic patients.