Insulinoma differential diagnosis: Difference between revisions
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/* Differentials for Hypoglycemia on the basis of Laboratory findings{{cite journal| author=Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER et al.| title=Evaluation and management of adult hypoglycemic disorders: an Endocrine Socie... |
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==Overview== | ==Overview== | ||
Insulinoma must be differentiated from other diseases that cause features of hypoglycemia like | Insulinoma must be differentiated from other diseases that cause features of [[hypoglycemia]] like [[altered mental status]]/[[confusion]], profuse [[sweating]] and visual disturbances ([[Blurred vision|blurring]]/[[diplopia]]). These are classified on the basis of laboratory findings into exogenous [[insulin]], [[oral hypoglycemic agent]]<nowiki/>s (e.g. [[sulphonylurea]]<nowiki/>s), [[nesidioblastosis]], [[insulin autoimmune hypoglycemia]]. | ||
==Differentiating insulinoma from other Diseases== | ==Differentiating insulinoma from other Diseases== | ||
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Insulinoma]]/[[Nesidioblastosis]]/ | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Insulinoma]]/[[Nesidioblastosis]]/PGPH<sup>†</sup> | ||
| style="background: #F5F5F5; padding: 5px;text-align: center;" |<55 | | style="background: #F5F5F5; padding: 5px;text-align: center;" |<55 | ||
| style="background: #F5F5F5; padding: 5px;text-align: center;" |≥200 | | style="background: #F5F5F5; padding: 5px;text-align: center;" |≥200 | ||
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|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Oral hypoglycemic agent | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Oral hypoglycemic agent]] | ||
| style="background: #F5F5F5; padding: 5px;text-align: center;" |<55 | | style="background: #F5F5F5; padding: 5px;text-align: center;" |<55 | ||
| style="background: #F5F5F5; padding: 5px;text-align: center;" |≥200 | | style="background: #F5F5F5; padding: 5px;text-align: center;" |≥200 | ||
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| style="background: #DCDCDC; padding: 5px; text-align: center;" | | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[IGF]]¤ | ||
| style="background: #F5F5F5; padding: 5px;text-align: center;" |<55 | | style="background: #F5F5F5; padding: 5px;text-align: center;" |<55 | ||
| style="background: #F5F5F5; padding: 5px;text-align: center;" |<200 | | style="background: #F5F5F5; padding: 5px;text-align: center;" |<200 | ||
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† PGPH= Post Gastric Bypass Hypoglycemia,<br>‡ Free C-peptide and proinsulin concentrations are low<br> | † PGPH= Post Gastric Bypass Hypoglycemia,<br>‡ Free C-peptide and proinsulin concentrations are low<br> | ||
¤ IGF= Insulin Growth Factor, Increased pro-IGF-2, free IGF-2, IGF-2/IGF-1 ratio | ¤ [[IGF]]= Insulin Growth Factor, Increased pro-IGF-2, free [[Insulin-like growth factor 2|IGF]]-2, IGF-2/[[IGF-1]] ratio | ||
==References== | ==References== | ||
Revision as of 16:46, 1 September 2017
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Insulinoma differential diagnosis On the Web |
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Risk calculators and risk factors for Insulinoma differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]
Overview
Insulinoma must be differentiated from other diseases that cause features of hypoglycemia like altered mental status/confusion, profuse sweating and visual disturbances (blurring/diplopia). These are classified on the basis of laboratory findings into exogenous insulin, oral hypoglycemic agents (e.g. sulphonylureas), nesidioblastosis, insulin autoimmune hypoglycemia.
Differentiating insulinoma from other Diseases
- Insulinoma must be differentiated from other diseases that cause features of hypoglycemia. These are classified on the basis of laboratory findings.
Differentials for Hypoglycemia on the basis of Laboratory findings[1]:
| Diagnoses | Laboratory Findings differentiating among causes of Hypoglycemia | |||||||
|---|---|---|---|---|---|---|---|---|
| S.Glucose (mg/dL) |
C Peptide (pmol/L) | S.Insulin (μU/mL) | S.Proinsulin (pmol/L) |
S. Beta hydroxybutyrate | Glucose increase after glucagon(mg/dL) | Oral Hypoglycemic agent | Antibodies to Insulin | |
| Normal/Fasting | <55 | <200 | <3 | <5 | >2.7 | <25 | - | - |
| Exogenous Insulin | <55 | <200 | >>3 | <5 | ≤2.7 | >25 | - | - |
| Insulinoma/Nesidioblastosis/PGPH† | <55 | ≥200 | ≥3 | ≥5 | ≤2.7 | >25 | - | - |
| Insulin Autoimmune hypoglycemia | <55 | >>200‡ | >>3 | >>5‡ | ≤2.7 | >25 | - | + |
| Oral hypoglycemic agent | <55 | ≥200 | ≥3 | ≥5 | ≤2.7 | >25 | + | - |
| IGF¤ | <55 | <200 | <3 | <5 | ≤2.7 | >25 | - | - |
† PGPH= Post Gastric Bypass Hypoglycemia,
‡ Free C-peptide and proinsulin concentrations are low
¤ IGF= Insulin Growth Factor, Increased pro-IGF-2, free IGF-2, IGF-2/IGF-1 ratio
References
- ↑ Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER; et al. (2009). "Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline". J Clin Endocrinol Metab. 94 (3): 709–28. doi:10.1210/jc.2008-1410. PMID 19088155.