Alfred F. Shwayhat, DO, MPH, CDR, MC, USN, David Brett-Major, MD, MPH, LCDR, MC, USN, and John A. Poremba, MD, Lt Col, USAF, MC
At the time of this writing, CDR Shwayhat was an attending physician in the division of endocrinology and metabolism, department of internal medicine at Navy Medical Center, San Diego, CA; LCDR Brett-Major was a physician in the department of medicine, National Naval Medical Center, Bethesda, MD; and Lt Col Poremba was an associate professor of medicine, division of endocrinology at the Uniformed Services University of the Health Sciences, Bethesda, MD. CDR Shwayhat is now an aerospace medicine physician at the Naval Aerospace Medicine Institute, Pensacola, FL; LCDR Brett-Major is now director of the Military Tropical Medicine Course at Navy Medicine Manpower, Personnel, Training, and Education Command, Bethesda, MD; and Lt Col Poremba is now an attending physician in the department of medicine at Hanscom Clinic, Hanscom Air Force Base, MA.
Months before this patient’s near collapse, the metabolic derangements caused by his cancer manifested in his marriage. This case demonstrates the need to consider insulinoma in healthy appearing patients who experience behavioral disturbances that otherwise might be treated only with counseling.
