For a 34-year-old new mother in Massachusetts, what looked like a case of postpartum depression turned out to be odd behavior with a less obvious cause: a tumor on her pancreas.
The woman's ordeal, in which her symptoms steadily worsened despite medication and psychiatric sessions, is recounted in this week's New England Journal of Medicine
The woman had experienced panic attacks, increased feelings of anxiety and hopelessness, and episodes of crying — all signs of postpartum depression. That diagnosis was soon made and she was given anti-anxiety medications, but they did not help her symptoms.
The woman had periodically experienced numbness in her lower lip during late pregnancy. A few months after giving birth, in addition to her other symptoms, she began to display odd behaviors such as repeatedly pouring cereal from one container to another, and growling. These episodes did not last long, and she later remembered little about them.
After more symptoms appeared, including blurred vision, confusion, fatigue and trouble speaking, she was admitted to the hospital.
Tests revealed she had low blood sugar levels, at 30 milligrams per deciliter. Normal blood sugar levels are around 70 mg/dl before meals.
Blood sugar levels this low are most often seen in people with diabetes who have been taking medications to lower their blood sugar. But this woman hadn't been taking such medications, according to the researchers at Massachusetts General Hospital who reported her case in the medicine journal.
An imaging scan showed a tumor, slightly less than half an inch long, on her pancreas. A little more detective work by the researchers showed that this tumor was indeed the cause of her symptoms.
The tumor, called an insulinoma, was producing excessive amounts of insulin — the hormone made by the pancreas that helps the body's cells take up sugar from the blood. When too much insulin is around, blood sugar levels decline.
The woman had surgery to remove the tumor, and her symptoms went away. She no longer needed her anxiety medications, or appointments with a psychiatrist.
The brain needs lots of sugar, and the signs of low blood sugar may include mood or thinking problems, such as feeling cranky or aggressive, and feeling nervous. This woman's symptoms were likely exacerbated by breast-feeding, which also requires the energy from lots of sugar, the researchers said.
Insulinomas are rare, occurring in about one in 1 million people each year.
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- Disease & Medical Conditions
- postpartum depression