ABSTRACT
In a 50 year old male sudden loss of consciousness resulted in a dislocated elbow. Under observation, repeated unconscious episodes were initially thought to be post traumatic epilepsy but led to a blood glucose which was low. Although fasting Insulin/Glucose ratios were not diagnostic there was a marked abnormality of serum Insulin/Glucose and Glucose/Insulin rations during a glucose tolerance test. Serum C-peptide levels were also elevated after glucose ingestion but not before. Although the diagnostic significance of these findings is not known, the suspicion of endogenous hyperinsulism was strong. Selective angiography was inconclusive. On September 17, 1986 a 75% distal pancreatectomy was done. Permanent section microscopy consistently showed islet cell adenomatosis with some uninvolved areas of the pancreas. Post operative recovery was smooth; there have been no further attacks and until now no post-operative medications have been required. Determination of fasting Insulin/Glucose ratios is planned at the patient's next visit