Pancreatic neuroendocrine tumour—insulinoma masquerading as a psychiatric illness

Karanth, Jnanaprakash B; Pai, Vishwas; Maribashetti, Kiran

doi:10.1136/bcr-2022-249698

Cited by 4 publications

(5 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Neuroglycopenic symptoms, on the other hand, are the central nervous system's response to reduced glucose availability and may include syncope, confusion, vision changes, anxiety, convulsions, coma, amnesia and, rarely, psychiatric symptoms [62,77]. To diagnose insulinomas, six criteria must be met: blood glucose levels must be less than or equal to 40 mg/dL, insulin levels must be greater than or equal to 36 pmol/L, C-peptide levels must be greater than or equal to 200 pmol/L, proinsulin levels must be greater than or equal to 5 pmol/L, beta-hydroxybutyrate levels must be less than or equal to 2.7 mmol/L and there must be no sulfonylurea metabolites in plasma or urine [78]. Ruling out other causes of hypoglycemia is also important in the diagnostic process.…”

Section: Insulinomasmentioning

confidence: 99%

“…Ruling out other causes of hypoglycemia is also important in the diagnostic process. The 72 h fasting test is considered the "gold standard" for confirming the diagnosis [78], although some studies suggest that a 2 h oral glucose tolerance test may be an alternative in an outpatient setting [79]. Most patients develop symptoms within 48 h [80].…”

Section: Insulinomasmentioning

confidence: 99%

“…Although pharmacotherapy is available, complete surgical excision is the preferred curative treatment, and incomplete resection may lead to persistent symptoms [78,81].…”

Section: Insulinomasmentioning

confidence: 99%

“…Insulin levels in the blood must be greater than or equal to 36 pmol/L [78]. Glucagon level of more than 500 to 1000 pg/mL (normal 50 to 150 pg/mL) [62].…”

Section: Pancreatic Nensmentioning

confidence: 99%

See 3 more Smart Citations

A Comprehensive Review on Neuroendocrine Neoplasms: Presentation, Pathophysiology and Management

Sultana

Kar

Verma

et al. 2023

JCM

View full text Add to dashboard Cite

This review focuses on neuroendocrine neoplasms (NENs), which represent a heterogeneous group of relatively uncommon tumors that arise from cells of the endocrine and nervous systems. Although diverse, these tumors share common features, such as an alike histological appearance, the presence of secretory granules and, often, the generation and release of hormones or biogenic amines. NENs have been categorized based on their clinical behavior, histology, anatomic location and proliferation rate—factors relevant to their treatment and prognosis. Previously, chiefly diagnosed by their clinical features, their presence incidental to widespread imaging techniques appears to be on the rise in the US and several other countries. In this light, this article summarizes their pathophysiology, staging and recent changes to clinical practice pertinent to their diagnosis and treatment. Neuroendocrine neoplasms (NENs) are a group of heterogeneous tumors with neuroendocrine differentiation that can arise from any organ. They account for 2% of all malignancies in the United States. A significant proportion of NEN patients experience endocrine imbalances consequent to increased amine or peptide hormone secretion, impacting their quality of life and prognosis. Over the last decade, pathologic categorization, diagnostic techniques and therapeutic choices for NENs—both well-differentiated neuroendocrine tumors (NETs) and poorly differentiated neuroendocrine carcinomas (NECs)—have appreciably evolved. Diagnosis of NEN mostly follows a suspicion from clinical features or incidental imaging findings. Hormonal or non-hormonal biomarkers (like serum serotonin, urine 5-HIAA, gastrin and VIP) and histology of a suspected NEN is, therefore, critical for both confirmation of the diagnosis and classification as an NET or NEC. Therapy for NENs has progressed recently based on a better molecular understanding, including the involvement of mTOR, VEGF and peptide receptor radionuclide therapy (PRRT), which add to the growing evidence supporting the possibility of treatment beyond complete resection. As the incidence of NENs is on the rise in the United States and several other countries, physicians are more likely to see these cases, and their better understanding may support earlier diagnosis and tailoring treatment to the patient. We have compiled clinically significant evidence for NENs, including relevant changes to clinical practice that have greatly updated our diagnostic and therapeutic approach for NEN patients.

show abstract

Section: Insulinomasmentioning

confidence: 99%

Section: Insulinomasmentioning

confidence: 99%

“…Although pharmacotherapy is available, complete surgical excision is the preferred curative treatment, and incomplete resection may lead to persistent symptoms [78,81].…”

Section: Insulinomasmentioning

confidence: 99%

“…Insulin levels in the blood must be greater than or equal to 36 pmol/L [78]. Glucagon level of more than 500 to 1000 pg/mL (normal 50 to 150 pg/mL) [62].…”

Section: Pancreatic Nensmentioning

confidence: 99%

See 2 more Smart Citations

A Comprehensive Review on Neuroendocrine Neoplasms: Presentation, Pathophysiology and Management

Sultana

Kar

Verma

et al. 2023

JCM

View full text Add to dashboard Cite

show abstract

“…[5,6] Psychiatric symptoms like panic attacks may also be due to insulinoma; however, this is extremely rare. [5,7]…”

Section: Insulinomamentioning

confidence: 99%

A review of functional pancreatic neuroendocrine tumors: Exploring the molecular pathogenesis, diagnosis and treatment

Alshareefy,

Cummins,

Mazzoleni

et al. 2023

Medicine

View full text Add to dashboard Cite

Pancreatic neuroendocrine tumors (PanNETs) are a rare subtype of pancreatic cancer and can be divided into functional (30–40%) and nonfunctional subtypes. The different subtypes of functional PanNETs (F-PanNETs) have a variety of classical presentations that raise suspicion for an underlying PanNET. It is estimated that 90% of PanNETs are sporadic, and the PI3K-Akt-mTOR and ATRX/DAXX signaling pathways have been recognized as key genetic pathways implicated in the pathogenesis. The other 10% of PanNETs may occur in the context of familial cancer syndromes such as MEN1. Chromogranin A is the most useful biomarker currently; however, several studies have shown limitations with its use, especially its prognostic value. Synaptophysin is a novel biomarker which has shown promising preliminary results however its use clinically has yet to be established. Blood tests assessing hormone levels, cross-sectional imaging, and endoscopic ultrasound remain at the core of establishing a diagnosis of F-PanNET. The treatment options for F-PanNETs include surgical methods such as enucleation, systemic therapies like chemotherapy and novel targeted therapies such as everolimus. The prognosis for F-PanNETs is more favorable than for nonfunctional PanNETs, however metastatic disease is associated with poor survival outcomes. Researchers should also focus their efforts on identifying novel pathways implicated in the pathogenesis of F-PanNETs in order to develop new targeted therapies that may reduce the need for surgical intervention and on the establishment of novel biomarkers that may reduce the need for invasive testing and allow for earlier detection of F-PanNETs.

show abstract

Glucose

2022

Reactions Weekly

View full text Add to dashboard Cite

Pancreatic neuroendocrine tumour—insulinoma masquerading as a psychiatric illness

Cited by 4 publications

References 7 publications

A Comprehensive Review on Neuroendocrine Neoplasms: Presentation, Pathophysiology and Management

A Comprehensive Review on Neuroendocrine Neoplasms: Presentation, Pathophysiology and Management

A review of functional pancreatic neuroendocrine tumors: Exploring the molecular pathogenesis, diagnosis and treatment

Glucose

Contact Info

Product

Resources

About