Peripheral neuropathy in association with insulinoma: clinical features and neuropathology of a new case.

Tintoré, María; Montalbán, J; Cervera, Carlos; Codina, A; Royo, Ignacio Ara; Crespo, Javier; Navarro, Cláudia Maria

doi:10.1136/jnnp.57.8.1009

Cited by 18 publications

(28 citation statements)

References 4 publications

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“…Patients suffering from recurrent hypoglycemia develop symmetric distal sensorimotor neuropathy including the following symptoms: numbness, weakness, muscle atrophy in both hands and feet, difficulty in walking, and painful distal paresthesiae with or without sensory loss (Jordan, 1933;Williams, 1955;Jaspan et al, 1982;Jayasinghe et al, 1983;Tintore et al, 1994;Puri et al, 2000). Patients suffering from recurrent hypoglycemia develop symmetric distal sensorimotor neuropathy including the following symptoms: numbness, weakness, muscle atrophy in both hands and feet, difficulty in walking, and painful distal paresthesiae with or without sensory loss (Jordan, 1933;Williams, 1955;Jaspan et al, 1982;Jayasinghe et al, 1983;Tintore et al, 1994;Puri et al, 2000).…”

Section: Neurophysiologic Observationsmentioning

confidence: 99%

“…With the development of electromyography, it was shown that individuals with prolonged hypoglycemia suffer from muscle denervation (Tintore et al, 1994). Some reports indicate that patients with paresis of the arms and legs 518 S. MOHSENI do not necessarily exhibit abnormalities in sensation (Silfverski€ old, 1946;Mulder et al, 1956), and that there are no anomalies in the dorsal root ganglia and dorsal roots after prolonged hypoglycemia (Moersch and Kernohan, 1938;Tom and Richardson, 1951;Tintore et al, 1994). Some reports indicate that patients with paresis of the arms and legs 518 S. MOHSENI do not necessarily exhibit abnormalities in sensation (Silfverski€ old, 1946;Mulder et al, 1956), and that there are no anomalies in the dorsal root ganglia and dorsal roots after prolonged hypoglycemia (Moersch and Kernohan, 1938;Tom and Richardson, 1951;Tintore et al, 1994).…”

Section: Neuropathologic Observationsmentioning

confidence: 99%

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Neurologic damage in hypoglycemia

Mohseni

2014

Handbook of Clinical Neurology

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Section: Neurophysiologic Observationsmentioning

confidence: 99%

Section: Neuropathologic Observationsmentioning

confidence: 99%

Neurologic damage in hypoglycemia

Mohseni

2014

Handbook of Clinical Neurology

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“…Somente 5-10% dos insulinomas são malignos e, nestes casos, geralmente são do tipo não funcionantes, onde a detecção normalmente só ocorre após longa evolução, devido aos sintomas compressivos locais (9). Embora nossa paciente não apresentasse evidên-cias clínicas de déficits neurológicos, estudos animais demonstram que a hipoglicemia insulino-induzida produz degeneração axonal aguda (10), podendo raramente levar a uma neuropatia distal simétrica predominantemente motora (11). Mais recentemente, Pozzessere e cols.…”

Section: Discussionunclassified

Insulinoma Maligno Produzindo Hipoglicemia

Meister

Boguszewski

Ioshii

et al. 2002

Arq Bras Endocrinol Metab

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RESUMORelatamos o caso de uma mulher de 53 anos com episódios de hipoglicemia espontânea com um ano de evolução. A paciente referia fraqueza, sudorese e tremores, especialmente após as refeições. A avaliação laboratorial confirmou hipoglicemia com altos níveis de insulina e peptídeo C. A tomografia axial computadorizada (TAC) de abdome evidenciou uma grande massa com calcificações na cauda do pâncreas. Após ressecção cirúrgica o exame histológico revelou insulinoma maligno. Após 12 meses de acompanhamento a paciente permanecia assintomática e normoglicêmica. We report on a case of a 53-year-old woman with episodes of spontaneous hypoglycemia in the last year, before her first visit in our outpatient clinic. She complained of weakness, sweating and trembling specially after meals. Blood tests confirmed low plasma glucose values and elevated insulin and C-peptide levels. An abdominal computed tomography (CT) scan showed a large mass with calcifications in the pancreas tail. Surgery was performed and histological evaluation revealed a malignant insulinoma. Since then, she has been followed for twelve months with no symptoms of hypoglycemia and no evidence of relapse.

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“…Perhaps, peripheral nerve impairment requires longer manifestation of a condition of hypoglycemia similar to that encountered in patients with insulinsecreting tumor. In fact, in this condition, both clinically symmetric polyneuropathy (7,9) and a reduction of motor conduction velocity (6, 8) have been described. The Erb-N13 CT was bilaterally affected in an insulinoma patient (no.…”

Section: Discussionmentioning

confidence: 99%

Effects of Spontaneous Chronic Hypoglycemia on Central and Peripheral Nervous System in Insulinoma Patients before and after Surgery: A Neurophysiological Follow-Up

Pozzessere¹,

Valle²,

D'alessio³

et al. 1997

The Journal of Clinical Endocrinology & Metabolism

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To investigate the effects of spontaneous chronic hypoglycemia on the peripheral and central nervous system, a multimodal neurophysiological evaluation [median somatosensory (mSEP), brain stem auditory (BAEP), and visual (VEP) evoked potentials recordings] was performed in seven insulinoma patients before and 3 and 6 months after surgical removal of tumor.Before surgery, mSEP findings showed abnormal reduction in peripheral wrist-Erb conduction velocity in three patients as well as a pathological increase in Erb-N13, N13-N20, and Erb-N20 conduction times in five cases. BAEP and VEP recordings gave pathological results in two patients. Moreover, during hypoglycemia, the III-V and I-V interpeak latencies of BAEPs were significantly prolonged (P Ͻ 0.01 and P Ͻ 0.005, respectively) compared to recordings in euglycemia.After 6 months, a mSEP recovery, even if partial was noted in four patients, BAEPs were normalized in one case, and VEPs were unmodified. Compared to presurgery data, these recordings showed a significant (P Ͻ 0.05), but incomplete, shortening of BAEPs (III-V and I-V interpeak latencies) and mSEPs (Erb-N13 and Erb-N20 conduction times).Our findings demonstrate that multiple and selective neurophysiological abnormalities are present in insulinoma patients, confirm that hypoglycemia impairs suddenly brain stem function, and show that after tumor removal, long recovery times for improvement of some neurophysiological anomalies are requested. (J Clin Endocrinol Metab 82: 1447-1451, 1997) I T IS WELL known that hypoglycemia depresses cerebral energy metabolism. Thus, it is likely to cause a temporary impairment of cerebral functions and, less frequently, can produce permanent brain damage and death (1, 2). Cortical and hippocampal atrophy and ventricular enlargement may occur (3); sometimes diffuse demyelinization has been observed (3).At the peripheral level, insulin-induced hypoglycemia has been shown to produce acute axonal degeneration in both nondiabetic and diabetic animals (4) and to alter the anterograde fast components of axonal transport in rats (5). Furthermore, a distal symmetrical predominantly motor neuropathy is a rare syndrome that can occur in patients with hypoglycemia secondary to insulinoma (6 -9).During the past few years, a number of studies have examined the effects of hypoglycemia on central nervous system functions, and neurophysiological as well as neuropsychological changes have been noted (10 -14). However, the extent and mechanisms of nervous system impairment during hypoglycemia have not yet been fully described.The electrophysiological techniques potentially offer objective means of assessing peripheral and central nervous system function (15). Moreover, the recording of electrical events occurring along the somatosensory, auditory, and visual pathways constitutes a noninvasive diagnostic tool in the detection of even subclinical nervous system impairments.To our knowledge, peripheral along with central nervous system function in patients suffering from spontaneous hyp...

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Peripheral neuropathy in association with insulinoma: clinical features and neuropathology of a new case.

Cited by 18 publications

References 4 publications

Neurologic damage in hypoglycemia

Neurologic damage in hypoglycemia

Insulinoma Maligno Produzindo Hipoglicemia

Effects of Spontaneous Chronic Hypoglycemia on Central and Peripheral Nervous System in Insulinoma Patients before and after Surgery: A Neurophysiological Follow-Up

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