Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a history of recurrent neuroglycopenic symptoms (confusion, visual disturbances, syncope) and autonomic symptoms (palpitations, diaphoresis, tremors) typically occurring in the fasting state or post-exertion. Symptoms are consistently relieved by glucose intake (Whippleโs triad). No history of MEN1 syndrome or family history of endocrine neoplasia. Current frequency of hypoglycemic episodes is [Number] per week.
Clinical Examination Findings
General appearance: Alert and oriented, no acute distress. Vitals: Stable. Skin: No evidence of neurofibromas, lipomas, or cafรฉ-au-lait spots. Abdominal exam: Soft, non-tender, non-distended, no palpable masses or hepatomegaly. Neurological exam: Intact, no focal deficits. Cardiovascular: Regular rate and rhythm, no murmurs.
Treatment Protocol
1. Surgical resection (enucleation or distal pancreatectomy) remains the gold standard. 2. Pre-operative stabilization with Diazoxide or Octreotide to manage hyperinsulinemia. 3. Continuous Glucose Monitoring (CGM) for glycemic control. 4. Referral for intraoperative ultrasound to localize occult lesions. 5. Post-operative monitoring for pancreatic fistula and endocrine insufficiency.