Loss of consciousness in a helicopter pilot as plausible first sign of insulinoma: a case report Loss of consciousness in a helicopter pilot

Main Article Content

Simone Pratò
Vittoria Didonna
Francesca Garletti
Giovanni Marfia
Adriano Barbaresi
Fabrizio Palumbo
Emanuele Garzia
Giuseppe Ciniglio Appiani
Luciano Riboldi
Luisella Vigna


occupational, Pilot, NET, insulinoma, curcumin


A 50-year-old man who worked as a helicopter rescue pilot transiently lost consciousness while piloting a helicopter rescue. In the diagnostic process, all tests for the main possible differential diagnoses of loss of consciousness (cardiological and neurological) were performed and yielded normal results. Blood chemistry tests revealed recurrent fasting hypoglycemia and Chromogranin A was at the upper limit of normal. Fine needle aspiration guided by endoscopic ultrasonography was used to diagnose insulinoma-type neuroendocrine tumor of the pancreas. According to the Italian policies, the occupational physician aims to maintain professional skills without neglecting flight safety. A careful analysis of the relationship between the characteristics of the state of health of the aviator and his specific work needs was carried out, and he was given the opportunity to continue working as a rescue pilot thanks to medical therapies associated with organizational interventions in the workplace.


Download data is not yet available.
Abstract 12 | PDF Downloads 0


1. Di Bartolomeo S, Gava P, Truhlář A, Sandberg M, Group TE. Cross-Sectional Investigation of HEMS Activities in Europe: A Feasibility Study. The Scientific World Journal. 2014;2014:1-5. doi:10.1155/2014/201570
2. Marinangeli F, Tomei M, Ursini ML, Ricotti V, Varrassi G. Helicopter emergency medical service in Italy: Reality and perspectives. Air Medical Journal. 2007;26(6):292-298. doi:10.1016/j.amj.2007.06.010
3. Hinkelbein J, Schwalbe M, Neuhaus C, Wetsch WA, Genzwürker H V. Incidents, accidents and fatalities in 40 years of German helicopter emergency medical system operations. European Journal of Anaesthesiology. 2011;28(11):766-773. doi:10.1097/EJA.0b013e328348d6a8
4. Kulke MH, Anthony LB, Bushnell DL, et al. NANETS Treatment Guidelines. Pancreas. 2010;39(6):735-752. doi:10.1097/MPA.0b013e3181ebb168
5. de Herder WW, Niederle B, Scoazec J-Y, et al. Well-Differentiated Pancreatic Tumor/Carcinoma: Insulinoma. Neuroendocrinology. 2006;84(3):183-188. doi:10.1159/000098010
6. Jensen RT, Cadiot G, Brandi ML, et al. ENETS Consensus Guidelines for the Management of Patients with Digestive Neuroendocrine Neoplasms: Functional Pancreatic Endocrine Tumor Syndromes. Neuroendocrinology. 2012;95(2):98-119. doi:10.1159/000335591
7. Wang H, Ba Y, Xing Q, Du J. Diagnostic value of endoscopic ultrasound for insulinoma localization: A systematic review and meta-analysis. Xiao G, ed. PLOS ONE. 2018;13(10):e0206099. doi:10.1371/journal.pone.0206099
8. Baziar N, Parohan M. The effects of curcumin supplementation on body mass index, body weight, and waist circumference in patients with nonalcoholic fatty liver disease: A systematic review and dose–response meta‐analysis of randomized controlled trials. Phytotherapy Research. 2020;34(3):464-474. doi:10.1002/ptr.6542
9. Lee S-M, Koh D, Chui WKL, Sum C-F. Diabetes Management and Hypoglycemia in Safety Sensitive Jobs. Safety and Health at Work. 2011;2(1):9-16. doi:10.5491/SHAW.2011.2.1.9
10. Iavicoli I, Gambelunghe A, Magrini A, et al. Diabetes and work: The need of a close collaboration between diabetologist and occupational physician. Nutrition, Metabolism and Cardiovascular Diseases. 2019;29(3):220-227. doi:10.1016/j.numecd.2018.10.012
11. Palumbo F, Marfia G, Navone SE, Garzia E, Bignami F CAG. Episodio lipotimico in pilota militare diabetico: percorso diagnostico e gestione dell’idoneità al volo. La Medicina del Lavoro. 2019;110(Suppl 2):29-32. doi:10.23749/mdl.v110i2-S.9740