Benign pancreatic insulinoma: preoperative and intraoperative sonographic localization

Gorman, Brian P.; Charboneau, J. William; James, E M; Reading, CC; Galiber, A K; Grant, C.A.; Heerden, JA van; Telander, R L; Service, F. John

doi:10.2214/ajr.147.5.929

Cited by 110 publications

(39 citation statements)

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“…The diagnosis of an insulinoma or proinsulinomas is confirmed biochemically with a simultaneous low blood sugar and inappropriately elevated serum insulin, pro-insulin and/or c-peptide levels [4,9,10] . Localization of the tumor is usually established by imaging or angiography, and the definitive treatment is surgical resection of the tumor followed by resolution of the hypoglycemia [11] .…”

Section: Introductionmentioning

confidence: 99%

Proinsulinoma causing severe hypoglycemia in a patient with type 1 diabetes mellitus

Bertheau¹,

Herceg

Malgor

et al. 2014

CRCP

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Case presentation: A 49 year male a 35 year history of Type 1 Diabetes Mellitus (T1DM) was evaluated for recurrent episodes of hypoglycemia. After being weaned off of all exogenous insulin, the patient continued to have frequent and severe episodes of hypoglycemia often associated with seizures. Results:During an observed hypoglycemic reaction in our office he was found to have a serum glucose level of 64 mg/dl, a serum insulin level of 64 μIU/ml (reference range is <17 μIU/ml) and a C-peptide level of 0.6 ng/ml (reference range is 0.8 ng/ml -3.1 ng/ml). Serum and urine sulfonylurea levels were negative. During a formal diagnostic 72 hour fast, he developed severe hypoglycemia within four hours of beginning the fast and seized. No diagnostic laboratory studies were obtained during the hypoglycemic event! He underwent surgical exploration, where a 0.8 cm well-differentiated, islet cell tumor was resected. Following resection of the tumor, the spontaneous hypoglycemia resolved, and maintenance exogenous insulin was reinstituted. Histoimmunochemical staining was positive for chromogranin, synaptophysin, amylin, and proinsulin but negative for insulin. Immunostaining of the tumor was also positive for Toll-like receptors-3 (TLR3) and Wnt5a.Conclusion: This is the first case report of a patient with a long history of T1DM who developed a recurrent hypoglycemia due to a proinsulin-secreting islet cell tumor which resolved following its resection.

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Section: Introductionmentioning

confidence: 99%

Proinsulinoma causing severe hypoglycemia in a patient with type 1 diabetes mellitus

Bertheau¹,

Herceg

Malgor

et al. 2014

CRCP

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“…It is important to remember that most insulinomas are intrapancreatic, solitary, small, and distributed equally through the head, body and tail of the pancreas. The sensitivity of transabdominal US in the localization of pancreatic insulinoma has ranged from 9 to 64% [19], while the combination of helical CT and US can yield a 100% overall diagnostic sensitivity [20]. …”

Section: Discussionmentioning

confidence: 99%

Neuropsychiatric Profiles of Patients with Insulinomas

et al. 2009

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Background/Aims: Insulinoma is a rare and potentially curable disease. It is often misdiagnosed as neurological or psychiatric disorder. This study was performed to characterize the neuropsychiatric symptoms (PNS) of the patients with insulinoma from a regional clinical center. Methods: All medical records of the patients with histopathologically identified insulinoma were reviewed during the period from 1998 to 2008. A case-control analysis was performed to compare the demographic data, details of clinical presentation, biochemical findings, tumor localization, and intraoperative findings between the patients with and without a prior misdiagnosis. Results: Among 42 patients with insulinoma, 25 patients with PNS were initially misdiagnosed as having a neurological or psychiatric disease, while 17 patients with no PNS were correctly diagnosed. Most (64%) of PNS cases were not diagnosed correctly until 12 months after the first consultation. In patients with PNS that remained undiagnosed for at least 5 years, the most frequent symptoms were confusion, convulsion, and visual disturbances. Twelve cases of PNS were initially misdiagnosed as epilepsy and 3 of them showed epileptiform discharges on electroencephalography. Conclusions: Episodic hypoglycemia induced by insulinoma can greatly mimic neurological and psychiatric presentation. A thorough history taking and inpatient assessment are necessary in evaluating recurrent neurological and psychiatric symptoms.

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“…Gorman and colleagues reported 10% insulinoma either isoechoic or hyperechoic to surrounding parenchyma that may be due to normal pancreatic parenchyma. It is less echogenic in younger patients than in older ones (Gorman et al, 1986). The ultrasound is operator dependent; thus, different detection rates were reported.…”

Section: Preoperative Transabdominal Ultrasoundmentioning

confidence: 98%

“…Besides the usual supine position, placing the patient in recumbent or upright oblique position may be necessary. Using the fluid-filled stomach or the spleen as acoustic window is also useful to examine the body and tail of pancreas (Galiber et al,1988;Gorman et al, 1986). Usually, insulinoma is detected as a solitary, rounded, well-defined, hypoechoic mass with smooth outlines (Galiber et al,1988).…”

Section: Preoperative Transabdominal Ultrasoundmentioning

confidence: 99%

Pancreatogenous Hypoglycemic Syndrome - Insulinoma or Non-Insulinoma Origin (NIPHS)

Lee¹,

Won²,

Tseng³

2011

Hypoglycemia - Causes and Occurrences

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Benign pancreatic insulinoma: preoperative and intraoperative sonographic localization

Cited by 110 publications

References 0 publications

Proinsulinoma causing severe hypoglycemia in a patient with type 1 diabetes mellitus

Proinsulinoma causing severe hypoglycemia in a patient with type 1 diabetes mellitus

Neuropsychiatric Profiles of Patients with Insulinomas

Pancreatogenous Hypoglycemic Syndrome - Insulinoma or Non-Insulinoma Origin (NIPHS)

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