Insulinoma overview: Difference between revisions
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==Natural History, Complications and Prognosis== | ==Natural History, Complications and Prognosis== | ||
If left untreated, patients with insulinoma may progress to develop [[autonomic]] symptoms, neuroglycopenenic symptoms, and symptoms of catecholaminergic response. | |||
==Staging== | ==Staging== | ||
Revision as of 21:52, 7 October 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]
Overview
An insulinoma is a tumour of the pancreas derived from the beta cells which while retaining the ability to synthesize and secrete insulin is autonomous of the normal feedback mechanisms. Patients present with symptomatic hypoglycemia which is ameliorated by feeding. The diagnosis of an insulinoma is usually made biochemically with low blood sugar, elevated insulin, pro-insulin and C-peptide levels and confirmed by medical imaging or angiography. The definitive treatment is surgery.
Historical Perspective
Pancreatic islet cells was first described by Paul Langerhans in 1869, while he was still a medical student. Insulin was first discovered by Frederick Banting and Charles Best in 1922 from a dog’s pancreas. In 1927, William J Mayo was the first to discover the association between hyperinsulinism and a functional pancreatic islet cell tumor. In 1929, Roscoe Graham was the first to perform surgical cure of an islet cell tumor.
Pathogenesis
On microscopic histopathological analysis, solid or gyriform patterns, usually without glands are characteristic findings of insulinoma. Insulinoma may occur as part of other genetic syndromes such as multiple endocrine neoplasia type 1 and von Hippel-Lindau syndrome.
Causes
There are no established causes for insulinoma.
Differential Diagnosis
Insulinoma must be differentiated from autoimmune hypoglycemia, hypoglycemia due to sulfonylurea or insulin abuse, factitious hypoglycemia, noninsulinoma pancreatogenic hypoglycemia syndrome (NIPHS), familial persistent hyperinsulinemia, and nesidioblastosis.[1]
Epidemiology and Demographics
The incidence of insulinoma is approximately 0.1 to 0.4 per 100,000 individuals worldwide. There is no racial predilection to the insulinoma. Females are more commonly affected with insulinoma than males.[2] The male to female ratio is approximately 2 to 3. The median age at diagnosis is 45.5 years.[2]
Risk Factors
Common risk factors in the development of insulinoma include family history of multiple endocrine neoplasia type 1 and von Hippel-Lindau syndrome, rural population, female gender, and age (40 years or older).
Screening
According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for insulinoma.[3]
Natural History, Complications and Prognosis
If left untreated, patients with insulinoma may progress to develop autonomic symptoms, neuroglycopenenic symptoms, and symptoms of catecholaminergic response.
Staging
History and Symptoms
Physical Examination
Laboratory Findings
CT
MRI
Ultrasonography
Other Imaging Findings
Other Diagnostic Findings
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
References
- ↑ Abboud, Bassam (2008). "Occult sporadic insulinoma: Localization and surgical strategy". World Journal of Gastroenterology. 14 (5): 657. doi:10.3748/wjg.14.657. ISSN 1007-9327.
- ↑ 2.0 2.1 Vázquez Quintana E (2004). "The surgical management of insulinoma". Bol Asoc Med P R. 96 (1): 33–8. PMID 15575328.
- ↑ USPTF.http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=insulinoma