Diagnosis of insulinoma using the ratios of serum concentrations of insulin and C-peptide to glucose during a 5-hour oral glucose tolerance test

Xu, Li; Zhang, Feng; Chen, Haibing; Yu, Haoyong; Zhou, Jian; Li, Ming; Li, Qing; Li, Lianxi; Yin, Jun; Liu, Fang; Bao, Yuqian; Han, Junfeng; Jia, Weiping

doi:10.1507/endocrj.ej16-0292

Cited by 10 publications

(20 citation statements)

References 34 publications

(31 reference statements)

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“…16 ng/mL after 90 min before decreasing to 6 ng/mL at 180 min. The results presented here are in good accordance with the established data …”

Section: Resultssupporting

confidence: 92%

“…The results presented here are in good accordance with the established data. 17 Another aspect is the modest specificity of the sample preparation, which in principle enriches all peptidic analytes more or less well from the blood sample. Here, antibody-based sample preparations have considerable advantages and should always be performed additionally to confirm the qualitative presence of the respective insulin.…”

Section: Proof Of Conceptmentioning

confidence: 99%

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Simplified quantification of insulin, its synthetic analogs and C‐peptide in human plasma by means of LC‐HRMS

Thomas

Yang

Petring

et al. 2020

Drug Testing and Analysis

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The quantification of peptide hormones by means of liquid chromatography (LC) coupled to mass spectrometry (MS) or other techniques (e.g. immunoassays) has been a challenging task in modern analytical chemistry. Especially for insulin, its synthetic analogs, and C‐peptide, reliable determinations are urgently needed due to their diagnostic value in the management of diabetes and insulin resistance and because of the illicit use of insulin as a performance‐enhancing agent in professional sports or as an effective toxin in forensic toxicology. The concomitant measurement of C‐peptide and insulin offers an established tool for the diagnostic workup of hypoglycemia (endogenous vs. exogenous hyperinsulinemia), characterizing hepatic insulin clearance, and the assessment of beta‐cell function (insulin secretion). Thus, the present approach offers the possibility to determine human insulin and its synthetic analogs (lispro, glulisine, aspart, glargine metabolite, degludec, detemir, porcine, and bovine) and C‐peptide simultaneously after sample preparation utilizing protein precipitation and a mixed‐mode cation‐exchange solid‐phase extraction, and subsequent detection by LC‐high resolution MS. The method was fully validated regarding the following parameters: specificity, limit of detection (0.2 ng/mL), limit of quantification (0.6 ng/mL), recovery (40–90%), accuracy (78–128%), linearity, precision (< 21%), carry over, robustness, and matrix effects. The proof‐of‐concept was shown by analyzing authentic plasma samples from adults with class II obesity and prediabetes collected in the course of an oral glucose tolerance test. All sample preparation steps were controlled by two stable isotope‐labeled internal standards, namely [[2H10] Leu B6, B11, B15, B17]‐insulin, and [[13C6] Leu 26, 30] C‐peptide.

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“…16 ng/mL after 90 min before decreasing to 6 ng/mL at 180 min. The results presented here are in good accordance with the established data …”

Section: Resultssupporting

confidence: 92%

Section: Proof Of Conceptmentioning

confidence: 99%

Simplified quantification of insulin, its synthetic analogs and C‐peptide in human plasma by means of LC‐HRMS

Thomas

Yang

Petring

et al. 2020

Drug Testing and Analysis

View full text Add to dashboard Cite

show abstract

“…According to a Mayo clinic study, 20% of insulinoma patients have additionally and 6% exclusively postprandial symptoms [ 24 ]. In patients with postprandial symptoms only, the corresponding plasma measurements can be performed postprandially or during a prolonged oral glucose tolerance test (OGTT) [ 1 , 7 , 25 ]. In the present cohort, postprandial symptoms were documented in 6 (8%) patients, but all of them had also symptoms provoked by fasting.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Outcomes of 79 Patients with an Insulinoma: A Nationwide Retrospective Study in Finland

Peltola

Hannula

Huhtala

et al. 2018

International Journal of Endocrinology

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Objective Insulinomas are rare pancreatic tumours. Population-based data on their incidence, clinical picture, diagnosis, and treatment are almost nonexistent. The aim of this study was to clarify these aspects in a nationwide cohort of insulinoma patients diagnosed during three decades. Design and Methods Retrospective analysis on all adult patients diagnosed with insulinoma in Finland during 1980–2010. Results Seventy-nine patients were diagnosed with insulinoma over the research period. The median follow-up from diagnosis to last control visit was one (min 0, max 31) year. The incidence increased from 0.5/million/year in the 1980s to 0.9/million/year in the 2000s (p = 0.002). The median diagnostic delay was 13 months and did not change over the study period. The mean age at diagnosis was 52 (SD 16) years. The overall imaging sensitivity improved from 39% in the 1980s to 98% in the 2000s (p < 0.001). Seventy-one (90%) of the patients underwent surgery with a curative aim, two (3%) had palliative surgery, and 6 (8%) were inoperable. There were no significant differences in the types of surgical procedures between the 1980s, 1990s, and 2000s; tumour enucleations comprised 43% of the operations, distal pancreatic resections 45%, and pancreaticoduodenectomies 12%, over the whole study period. Of the patients who underwent surgery with a curative aim, 89% had a full recovery. Postoperative complications occurred in half of the patients, but postoperative mortality was rare. Conclusions The incidence of insulinomas has increased during the past three decades. Despite the improved diagnostic options, diagnostic delay has remained unchanged. To shorten the delay, clinicians should be informed and alert to consider the possibility of hypoglycemia and insulinoma, when symptomatic attacks are investigated in different sectors of the healthcare system. Developing the surgical treatment is another major target, in order to lower the overall complication rate, without compromising the high cure rate of insulinomas.

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“…Insulinoma is the most common functional neuroendocrine tumor of the pancreas [2] and its incidence is 0.396 per 100,000 person-years [1,[3][4][5], accounting for 1~2% of all pancreatic neoplasms [6]. Surgical resection is the only effective treatment for pancreatic insulinomas [7][8][9][10][11], and results in curing almost 95% of patients.…”

Section: Discussionmentioning

confidence: 99%

Analysis of a series for surgical management of insulinomas in central China

Qiao

Líu

Hu³

et al. 2021

Preprint

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The aims of this study were to summarize the characteristics of insulinoma in central China and to present our experience with surgical management in the Department of Hepatobiliary and Pancreatic Surgery of The First Affiliated Hospital of Zhengzhou University. 617 patients were enrolled in this retrospective analysis, including 89 cases of insulinoma and 528 cases of other pancreatic tumors. All patients had been confirmed by histopathology reports and underwent surgical treatment. Medical data and operative notes were incorporated into the database. Among the 617 patients, 4 died during the perioperative period. In the insulinoma group, no deaths occurred. The average size of the insulinoma tumor was 1.4±0.8 cm. The ratio of open surgical procedure (57) to laparoscopic resection (32) was 1.8/1. The mean interoperation blood loss was significantly lower in the laparoscopic group (LA) (mean 35.2±17.4ml, range from 10 to 170ml) than that in the open surgical (OA) group (mean 64.7±38.6ml, range from 25 to 400ml). The mean postoperative hospital stay was also lower in the LA group (mean 8.1 ± 3.2days, range from 5 to 20 days) than that in the OA group (Mean 13.1±8.2days, range from 9 to 60 days). There was no significant difference for postoperative complications between the two groups (LA:37.5% vs OA:40.3% ). The rate of clinically significant postoperative-pancreatic-fistula (POPF) was 21.3 %, and there was only one case of C-degree-POPF. The average length of postoperative- gastrointestinal function recovery was 2.8 ± 0.9 days. And the average length of blood glucose fluctuation was 18±7.2 days. During the follow-up, 2 cases were found to be hypoglycemic again, and the rate of significant weight loss was 57.3% (51/89). Insulinoma was rare among patients who underwent surgical treatment at the Department. Their cases were benign, and their treatment was unproblematic. However, there was a small group of cases that could be associated with problematic clinical situations, and, therefore, treatment of patients with insulinoma should be conducted at specialist centers. Correct diagnostic and therapeutic management, involving close cooperation between multiple medical specialists, results in completely curing most patients.

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Diagnosis of insulinoma using the ratios of serum concentrations of insulin and C-peptide to glucose during a 5-hour oral glucose tolerance test

Cited by 10 publications

References 34 publications

Simplified quantification of insulin, its synthetic analogs and C‐peptide in human plasma by means of LC‐HRMS

Simplified quantification of insulin, its synthetic analogs and C‐peptide in human plasma by means of LC‐HRMS

Characteristics and Outcomes of 79 Patients with an Insulinoma: A Nationwide Retrospective Study in Finland

Analysis of a series for surgical management of insulinomas in central China

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