Insulinoma natural history, complications and prognosis: Difference between revisions
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{{CMG}}; {{AE}} {{ADS}} | {{CMG}}; {{AE}} {{ADS}} | ||
==Overview== | ==Overview== | ||
If left untreated, patients with insulinoma may progress to develop [[seizures]], [[coma]] and | If left untreated, patients with insulinoma may progress to develop [[seizures]], [[coma]] and even death. Prognosis is generally excellent for benign insulinoma after the removal of the [[tumor]]. Recurrence rates are higher in those associated with [[MEN1]] syndrome. | ||
==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
===Natural History=== | ===Natural History=== | ||
*The symptoms of insulinoma are found in any age group and start with neuroglycopenic symptoms such as [[altered mental status]], visual disturbances, [[confusion]] and adrenergic symptoms such as profuse [[sweating]], [[palpitations]] and [[tremors]]. | *The symptoms of insulinoma are found in any age group and start with [[Insulinoma history and symptoms|neuroglycopenic symptoms]] such as [[altered mental status]], [[Visual disturbance|visual disturbances]], [[confusion]] and [[adrenergic]] symptoms such as profuse [[sweating]], [[palpitations]] and [[tremors]]. | ||
*If left untreated, hypoglycemia progresses in frequency, although the [[tumor]] size remains small.<ref name="urlNatural History of Untreated Insulinoma over a Course of 7 Years : Endocrine Neoplasia: Tumorigenesis and Therapeutics">{{cite web |url=http://press.endocrine.org/doi/abs/10.1210/endo-meetings.2015.TB.2.THR-316 |title=Natural History of Untreated Insulinoma over a Course of 7 Years : Endocrine Neoplasia: Tumorigenesis and Therapeutics |format= |work= |accessdate=}}</ref> | *If left untreated, [[hypoglycemia|hypoglycemic episodes]] progresses in frequency, although the [[tumor]] size remains small. <ref name="urlNatural History of Untreated Insulinoma over a Course of 7 Years : Endocrine Neoplasia: Tumorigenesis and Therapeutics">{{cite web |url=http://press.endocrine.org/doi/abs/10.1210/endo-meetings.2015.TB.2.THR-316 |title=Natural History of Untreated Insulinoma over a Course of 7 Years : Endocrine Neoplasia: Tumorigenesis and Therapeutics |format= |work= |accessdate=}}</ref> | ||
===Complications=== | ===Complications=== | ||
*Common complications of insulinoma | *Common [[complications]] of insulinoma are due to [[hypoglycemia]] include:<ref name="pmid15258206">{{cite journal| author=Graves TD, Gandhi S, Smith SJ, Sisodiya SM, Conway GS| title=Misdiagnosis of seizures: insulinoma presenting as adult-onset seizure disorder. | journal=J Neurol Neurosurg Psychiatry | year= 2004 | volume= 75 | issue= 8 | pages= 1091-2 | pmid=15258206 | doi=10.1136/jnnp.2003.029249 | pmc=1739168 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15258206 }} </ref> | ||
**[[Seizures]] | |||
**[[Coma]] | **[[Coma]] | ||
**Death | **Death | ||
===Prognosis=== | ===Prognosis=== | ||
*90% insulinomas are [[benign]] and they are generally cured after the removal of the [[tumor]], so benign insulinoma is associated with the most favorable prognosis. <ref name="pmid1677058">{{cite journal| author=Service FJ, McMahon MM, O'Brien PC, Ballard DJ| title=Functioning insulinoma--incidence, recurrence, and long-term survival of patients: a 60-year study. | journal=Mayo Clin Proc | year= 1991 | volume= 66 | issue= 7 | pages= 711-9 | pmid=1677058 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1677058 }} </ref> | *90% insulinomas are [[benign]] and they are generally cured after the removal of the [[tumor]], so benign insulinoma is associated with the most favorable [[prognosis]]. <ref name="pmid1677058">{{cite journal| author=Service FJ, McMahon MM, O'Brien PC, Ballard DJ| title=Functioning insulinoma--incidence, recurrence, and long-term survival of patients: a 60-year study. | journal=Mayo Clin Proc | year= 1991 | volume= 66 | issue= 7 | pages= 711-9 | pmid=1677058 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1677058 }} </ref> | ||
*The prognosis varies with the [[malignant]] potential of the [[tumor]]; | *The [[prognosis]] varies with the [[malignant]] potential of the [[tumor]]; grade 1 and 2 [[tumor]] have the most favorable prognosis. | ||
*[[Malignant]] insulinomas: In a study of 10 patients, the first 4 who presented with lymph node [[metastasis]] | *[[Malignant]] insulinomas: In a study of 10 patients, the first 4 who presented with [[lymph node]] [[metastasis]] after surgical excision, maintained a prolonged tumor-free survival. The next four patients presented with [[metastasis]] to the [[liver]], which appeared years after the initial [[diagnosis]] and presumed curative [[surgery]]. One patient presented with a large [[Alpha-fetoprotein|α-fetoprotein]]-secreting [[liver]] mass. Finally, 9 of the 10 patients had a prolonged survival.<ref name="pmid15937909">{{cite journal| author=Hirshberg B, Cochran C, Skarulis MC, Libutti SK, Alexander HR, Wood BJ et al.| title=Malignant insulinoma: spectrum of unusual clinical features. | journal=Cancer | year= 2005 | volume= 104 | issue= 2 | pages= 264-72 | pmid=15937909 | doi=10.1002/cncr.21179 | pmc=4136659 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15937909 }} </ref> | ||
==References== | ==References== | ||
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Latest revision as of 15:05, 5 December 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]
Overview
If left untreated, patients with insulinoma may progress to develop seizures, coma and even death. Prognosis is generally excellent for benign insulinoma after the removal of the tumor. Recurrence rates are higher in those associated with MEN1 syndrome.
Natural History, Complications, and Prognosis
Natural History
- The symptoms of insulinoma are found in any age group and start with neuroglycopenic symptoms such as altered mental status, visual disturbances, confusion and adrenergic symptoms such as profuse sweating, palpitations and tremors.
- If left untreated, hypoglycemic episodes progresses in frequency, although the tumor size remains small. [1]
Complications
- Common complications of insulinoma are due to hypoglycemia include:[2]
Prognosis
- 90% insulinomas are benign and they are generally cured after the removal of the tumor, so benign insulinoma is associated with the most favorable prognosis. [3]
- The prognosis varies with the malignant potential of the tumor; grade 1 and 2 tumor have the most favorable prognosis.
- Malignant insulinomas: In a study of 10 patients, the first 4 who presented with lymph node metastasis after surgical excision, maintained a prolonged tumor-free survival. The next four patients presented with metastasis to the liver, which appeared years after the initial diagnosis and presumed curative surgery. One patient presented with a large α-fetoprotein-secreting liver mass. Finally, 9 of the 10 patients had a prolonged survival.[4]
References
- ↑ "Natural History of Untreated Insulinoma over a Course of 7 Years : Endocrine Neoplasia: Tumorigenesis and Therapeutics".
- ↑ Graves TD, Gandhi S, Smith SJ, Sisodiya SM, Conway GS (2004). "Misdiagnosis of seizures: insulinoma presenting as adult-onset seizure disorder". J Neurol Neurosurg Psychiatry. 75 (8): 1091–2. doi:10.1136/jnnp.2003.029249. PMC 1739168. PMID 15258206.
- ↑ Service FJ, McMahon MM, O'Brien PC, Ballard DJ (1991). "Functioning insulinoma--incidence, recurrence, and long-term survival of patients: a 60-year study". Mayo Clin Proc. 66 (7): 711–9. PMID 1677058.
- ↑ Hirshberg B, Cochran C, Skarulis MC, Libutti SK, Alexander HR, Wood BJ; et al. (2005). "Malignant insulinoma: spectrum of unusual clinical features". Cancer. 104 (2): 264–72. doi:10.1002/cncr.21179. PMC 4136659. PMID 15937909.