Elusive early diagnosis of insulinomas

A 62-year-old female presented to a tertiary hospital for a syncopal episode after being discharged from the emergency room of a neighboring university hospital. The patient complained of syncope and other symptoms gradually worsening over the past 5 years. Her symptoms included weakness, loss of consciousness, forgetfulness, nightmares, confusion paranoia and involuntary movements of her upper and lower extremities. She also complained of frequent falls of unknown etiology. On several occasions during these episodes, her husband had to revive her with chocolate bars after prolonged activity. An insulinoma undercover of psychogenic crises was diagnosed after several years and after several visits to different specialty groups: notably psychiatry, neurology, neuropsychiatry, and cardiology.