Insulinoma


Insulinoma

Infobox_Disease
Name = PAGENAME


Caption = Histopathology of pancreatic endocrine tumor (insulinoma).
DiseasesDB = 6830
ICD10 = ICD10|C|25|4|c|15, ICD10|D|13|7|d|10
ICD9 = ICD9|157.4, ICD9|211.7
ICDO = 8151
OMIM =
MedlinePlus =
eMedicineSubj = med
eMedicineTopic = 2677
MeshID = D007340
An insulinoma is a tumour of the pancreas derived from the beta cells which while retaining the ability to synthesize and secrete insulin is autonomous of the normal feedback mechanisms. Patients present with symptomatic hypoglycemia which is ameliorated by feeding. The diagnosis of an insulinoma is usually made biochemically with low blood sugar, elevated insulin, pro-insulin and C-peptide levels and confirmed by medical imaging or angiography. The definitive treatment is surgery.

Features

Insulinomas are rare neuroendocrine tumours with an incidence estimated at 1 to 4 new cases per million persons per year. Insulinoma is one of the most common types of tumour arising from the islets of Langerhans cells (pancreatic endocrine tumours). Estimates of malignancy (metastases) range from 5% to 30%. Over 99% of insulinomas originate in the pancreas, with rare cases from ectopic pancreatic tissue. About 5% of cases are associated with tumours of the parathyroid glands and the pituitary (Multiple endocrine neoplasia type 1) and are more likely to be multiple and malignant. Most insulinomas are small, less than 2 cm.

igns and Symptoms

Patients with insulinomas usually develop neuroglycopenic symptoms. These include recurrent headache, lethargy, diplopia, and blurred vision, particularly with exercise or fasting. Severe hypoglycemia may result in seizures, coma, and permanent neurological damage. Symptoms resulting from the catecholaminergic response to hypoglycemia (i.e. tremulousness, palpitations, tachycardia, sweating, hunger, anxiety, nausea) are not as common. Sudden weight gain (the patient can become massively obese) is sometimes seen.

Diagnosis

The diagnosis of insulinoma is suspected in a patient with symptomatic fasting hypoglycemia. The conditions of Whipple’s triad need to be met for the diagnosis of "true hypoglycemia" to be made:

#symptoms and signs of hypoglycemia,
#concomitant plasma glucose level of 45 mg/dL (2.5 mmol/L) or less, and
#reversibility of symptoms with administration of glucose.

Blood tests

The following blood tests are needed to diagnose insulinoma:

*glucose
*insulin
*C-peptide

If available, a proinsulin level might be useful as well. Other blood tests may help rule out other conditions which can cause hypoglycemia.

uppression tests

Normally, endogenous insulin production is suppressed in the setting of hypoglycemia. A 72-hour fast, usually supervised in a hospital setting, can be done to see if insulin levels fail to suppress, which is a strong indicator of the presence of an insulin-secreting tumour.:During the test, the patient may have calorie-free and caffeine-free liquids. Capillary blood glucose is measured every 4 hours using a reflectance meter, until values < 60 mg/dL (3.3 mmol/L) are obtained. Then, the frequency of blood glucose measurement is increased to every hour until values are < 49 mg/dL (2.7 mmol/L). At that point, or when the patient has symptoms of hypoglycemia, a blood test is drawn for serum glucose, insulin, proinsulin, and C-peptide levels. The fast is stopped at that point, and the hypoglycemia treated with intravenous dextrose or calorie-containing food or drink.

Diagnostic imaging

The insulinoma might be localized by non-invasive means, using ultrasound, CT scan, or by MRI techniques. An Indium-111 pentetreotide scan is more sensitive than ultrasond, CT, or MRI for detection of somatostatin receptor positive tumors.

Sometimes, angiography with percutaneous transhepatic pancreatic vein catheterization to sample the blood for insulin levels is required. Calcium can be injected into selected arteries to stimulate insulin release from various parts of the pancreas, which can be measured by sampling blood from their respective veins. The use of calcium stimulation improves the specificity of this test.

During surgery to remove an insulinoma, an intra-operative ultrasound can sometimes localize the tumour, which helps guide the surgeon in the operation and has a higher sensitivity than noninvasive imaging tests.

Treatment

The definitive management is surgical removal of the insulinoma. This may involve removing part of the pancreas as well (Whipple procedure and distal pancreatectomy).
Medications such as diazoxide and somatostatin can be used to block the release of insulin for patients who are not surgical candidates or who otherwise have inoperable tumours.
Streptozotocin is used in islet cell carcinomas which produce excessive insulin. Combination chemotherapy is used: either doxorubicin + streptozotocin, or fluorouracil + streptotozocin in patients where doxorubicin is contraindicated. [http://www.cancer.gov/cancertopics/pdq/treatment/isletcell/HealthProfessional/page6]
In metastasizing tumours with intrahepatic growth, hepatic arterial occlusion or embolization can be used. [http://www.nci.nih.gov/cancertopics/pdq/treatment/isletcell/Patient/page5]

Prognosis

Most patients with benign insulinomas can be cured with surgery. Persistent or recurrent hypoglycemia after surgery tends to occur in patients with multiple tumours. About two percent of patients develop diabetes mellitus after their surgery.

History

Hypoglycemia was first recognized in the 19th century. In the 1920’s, after the discovery of insulin and its use in the treatment of diabetics, hyperinsulinism was suspected to be a cause of hypoglycemia in non-diabetics. The first report of a surgical cure of hypoglycemia by removing an islet cell tumour was in 1929.

ee also

*hypoglycemia
*causes of hypoglycemia
*pancreas

External links

* [http://www.endotext.org/guthormones/guthormone4/guthormoneframe4.htm www.endotext.org article]


=Additional

References

*Larsen: Williams Textbook of Endocrinology, 10th ed., 2003
*Doppman JL, et al. "Localization of Insulinomas to Regions of the Pancreas by Intra-arterial Stimulation with Calcium". Ann of Int Med. 1995 Aug 15; 123(4):269-273 PMID 7611592
* [http://www.uptodate.com/ Service FJ. "Insulinoma". In: UpToDate, Rose, BD (Ed), UpToDate, Waltham, MA, 2005.]


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Look at other dictionaries:

  • insulinoma — m. endoc. Tumor en los islotes de Langerhans del páncreas. Los síntomas que produce (sudoración, temblor, náuseas, vómitos, aumento de la frecuencia cardíaca, ansiedad y sufrimiento cerebral) están ocasionados por la hipoglucemia que se genera en …   Diccionario médico

  • insulinoma — insulinoma. m. Med. Tumor, generalmente pancreático, que segrega insulina de manera independiente …   Enciclopedia Universal

  • insulinoma — m. Med. Tumor, generalmente pancreático, que segrega insulina de manera independiente …   Diccionario de la lengua española

  • Insulinoma — El insulinoma es un tumor del páncreas endocrino. Se origina en las células β y es más frecuente en cuerpo y cola. Cursan con la triada de Whipple: Hipoglucemia, sin tensión baja. Síntomas hipoglucémicos al esfuerzo. Se corrige al tomar azúcar.… …   Wikipedia Español

  • insulinoma — /in seuh leuh noh meuh, ins yeuh /, n., pl. insulinomas, insulinomata / meuh teuh/. Pathol. a benign tumor of the insulin secreting cells of the pancreas that may produce signs of hypoglycemia. Also, insuloma /in seuh loh meuh, ins yeuh /. Also… …   Universalium

  • insulinoma — noun A tumour of the pancreas that secretes insulin …   Wiktionary

  • insulinoma — An islet cell adenoma that secretes insulin. * * * in·su·lin·o·ma .in(t) s(ə )lə nō mə n, pl mas also ma·ta mət ə a usu. benign insulin secreting tumor of the islets of Langerhans * * * n …   Medical dictionary

  • insulinoma — n. insuloma, tumor (usually benign) of the beta cells in the pancreatic islets which causes increased insulin production (Medicine) …   English contemporary dictionary

  • insulinoma — in·su·li·no·ma …   English syllables

  • insulinoma — n. an insulin producing and usually benign tumour of the beta cells in the islets of Langerhans of the pancreas. Symptoms can include sweating, faintness, episodic loss of consciousness, and other features of hypoglycaemia (see Whipple s triad).… …   The new mediacal dictionary