Insulinoma Presenting with Long-Standing Depression, Primary Hypogonadism, and Sertoli Cell Only Syndrome

The aim was to report an unusual case of insulinoma presenting with long-standing depression and primary testicular failure. We describe a 34-year-old male with clinical, laboratory, and radiologic data consistent with islet cell tumor and seminiferous tubule failure primary hypogonadism. The literature is reviewed relative to the component of this syndrome, and a possible association is discussed. The subject was investigated for a long-standing history of depression requiring medical attention because of mental confusion and slurred speech and was found to have an insulinoma. He was diagnosed with primary gonadal failure and physical examination showed no evidence of dysmorphic features. Chromosomal analysis revealed normal 46 XY and testicular biopsy showed Sertoli cell only syndrome (SCOS). Biochemistry revealed endogenous hyperinsulinism and histology confirmed an islet cell tumor. He remained euglycemic postoperatively and on followup. From this report, we emphasize drawing clinicians' attention to the possibility of an association between insulinoma and primary testicular failure and suggest consideration of this diagnosis in patients with hypergonadotropic hypogonadism who may present with infertility. 1. Introduction Primary infertility and insulinoma have not been elucidated previously. Here, we report a patient with a history of long-standing symptoms of depression and hypogonadism and neuroglycopenic symptoms of recurrent episodic hypoglycemia. At presentation he complained of slurred speech, double vision, and feeling of blackout. Further assessment also revealed reduced libido and erectile dysfunction. Laboratory evaluation showed elevated serum FSH, azoospermia, and fasting hyperinsulinism confirmed to be an islet cell tumor. Hypoglycemic symptoms resolved following partial pancreatectomy. 2. Case Report A 34-year-old male was referred for further assessment of insulinoma in 2011. Prior to that he had several years of depression including suicidal thoughts and had been seeing a clinical psychologist. His symptoms were that of episodic slurred speech, double vision, and blackout. The symptoms were worsened by exertion as evidenced by several home blood glucose readings of ≤2？mmol/L. He was never sexually active and did not smoke, drink alcohol, or use any recreational drugs or hypoglycemic medications. There was no family history of diabetes or hypoglycemia. Clinical examination revealed body weight to be 65？kg, height 174.6？cm, and body mass index 21.4？kg/m2. No evidence of disproportionate body segments was found. He had normal body and