DOI: 10.12890/2026_006552

GLP-1 receptor agonist associated unmasking of insulinoma

Authors

  • Eden Simonov Maccabi Healthcare Services (MHS), Bat Yam, Israel; Internal Medicine ‘C’, Shamir Medical Center, Zerifin, Israel, affiliated to the Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
  • Rina Berger Internal Medicine ‘C’, Shamir Medical Center, Zerifin, Israel, affiliated to the Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
  • Olga Shishkina Department of Radiology, Shamir Medical Center, Zerifin, Israel, affiliated to the Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
  • Alexander Sivokha Internal Medicine ‘C’, Shamir Medical Center, Zerifin, Israel, affiliated to the Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
  • Dror Cantrell Internal Medicine ‘C’, Shamir Medical Center, Zerifin, Israel, affiliated to the Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel; Endocrine Institute, Shamir Medical Center, Zerifin, Israel, affiliated to the Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel

Drorcantrell@gmail.com

Keywords

Insulinoma, glucagon-like peptide-1 receptor agonists (GLP-1RAs), hypoglycaemia

Abstract

Background: Insulinoma is a rare functional pancreatic neuroendocrine tumour and the most common cause of endogenous hyperinsulinaemic hypoglycaemia in adults. Diagnosis is frequently delayed due to non-specific and intermittent symptoms, and a high index of suspicion is needed.
Case description: We report the case of a 40-year-old non-diabetic woman who presented with recurrent episodes of weakness shortly after initiation of a glucagon-like peptide-1 receptor agonist (GLP-1RA). Laboratory evaluation demonstrated inappropriately elevated insulin and C-peptide levels during documented hypoglycaemic events, consistent with endogenous hyperinsulinaemia. Autoimmune and exogenous causes were excluded. Imaging studies identified a 2 cm hypervascular pancreatic lesion, with functional imaging confirming somatostatin receptor avidity consistent with an insulin-secreting tumour. The patient was initially treated with diazoxide as a bridge to definitive management. She subsequently underwent laparoscopic distal pancreatectomy, with histopathology confirming a well-differentiated pancreatic neuroendocrine tumour (WHO Grade 1). Following surgery, hypoglycaemia resolved completely.
Conclusion: This case highlights the potential of GLP-1 receptor agonist therapy to unmask an insulinoma. Many benign insulinomas exhibit abundant expression of GLP-1 receptors. While a high index of suspicion remains essential, awareness of the emerging association between the incretin-based therapies and unexplained hypoglycaemia may facilitate earlier diagnosis.

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References

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Published

2026-05-05

Issue

Vol. 13 No. 5 (2026)

Categories

How to Cite

1.
Simonov E, Berger R, Shishkina O, Sivokha A, Cantrell D. GLP-1 receptor agonist associated unmasking of insulinoma. EJCRIM [Internet]. 2026 May 5 [cited 2026 Nov. 3];13(5). Available from: https://ejcrim.com/index.php/ejcrim/article/view/6552