Functioning pancreatic islet cell carcinoma presents challenging clinical problems. Hypoglycemia due to hyperinsulinism may be especially severe and may require long-term medical management, since curative surgery is often impossible. In addition to hyperinsulinism, islet cell carcinoma may secrete other hormones which independently complicate management. Islet cell carcinoma occurred in a patient who presented with severe hypoglycemia due to hyperinsulinism; later evidence of ectopic adrenocorticotropic hormone secretion developed.
A 24-year-old white man on active duty in the Navy was admitted to the Naval Hospital, Oakland, Calif, because of bizarre behavior.Four days prior to admission the first episode of abnormal behavior occurred, characterized by flailing arm movements and inappropriate answers to questions. The episode began suddenly, lasted about 30 minutes, and subsided spontaneously. A similar episode occurred during the early morning on the day of admission. The patient denied previous abnormal behavior or symptoms of hypoglycemia. At the time