Insulinoma diagnostic criteria: Difference between revisions
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*The gold standard for diagnosis classically had been 72 hour fasting test<ref name="pmid16253900">{{cite journal| author=Grant CS| title=Insulinoma. | journal=Best Pract Res Clin Gastroenterol | year= 2005 | volume= 19 | issue= 5 | pages= 783-98 | pmid=16253900 | doi=10.1016/j.bpg.2005.05.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16253900 }} </ref><ref name="MetzJensen2008">{{cite journal|last1=Metz|first1=David C.|last2=Jensen|first2=Robert T.|title=Gastrointestinal Neuroendocrine Tumors: Pancreatic Endocrine Tumors|journal=Gastroenterology|volume=135|issue=5|year=2008|pages=1469–1492|issn=00165085|doi=10.1053/j.gastro.2008.05.047}}</ref> | *The gold standard for diagnosis classically had been 72 hour fasting test<ref name="pmid16253900">{{cite journal| author=Grant CS| title=Insulinoma. | journal=Best Pract Res Clin Gastroenterol | year= 2005 | volume= 19 | issue= 5 | pages= 783-98 | pmid=16253900 | doi=10.1016/j.bpg.2005.05.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16253900 }} </ref><ref name="MetzJensen2008">{{cite journal|last1=Metz|first1=David C.|last2=Jensen|first2=Robert T.|title=Gastrointestinal Neuroendocrine Tumors: Pancreatic Endocrine Tumors|journal=Gastroenterology|volume=135|issue=5|year=2008|pages=1469–1492|issn=00165085|doi=10.1053/j.gastro.2008.05.047}}</ref> | ||
**33% patients develop symptoms in 12 hours, 80% at 24 hours, 90% after 48 hours and 100% after 72 hours of fasting. | **33% patients develop symptoms in 12 hours, 80% at 24 hours, 90% after 48 hours and 100% after 72 hours of fasting. | ||
{{familytree/start}}<nowiki>{{familytree | | | | | | | | | A01 | | | | | |A01=Suspicion of Insulinoma}} | |||
{{familytree | | | | | | | | | |!| | | | | | | | }} | |||
{{familytree | | | | | | | | | B01 | | | | | |B01=Whipple's triad confirmed}} | |||
{{familytree | | | | | | | | | |!| | | | | | | | }} | |||
{{familytree | | | | | | | | | C01 | | | | | |C01=72 hour fast}} | |||
{{familytree | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.| }} | |||
{{familytree | | D01 | | | | | | | | | | | |D02|D01=Positive|D02=Negative}} | |||
{{familytree | | |!| | | | | | | | | | | | | |!| }} | |||
{{familytree | | D01 | | | | | | | | | | | |D02|D01=D01'<br>D01''|D02=D02'<br>D02''}} | |||
{{familytree | | |!| | | | | | | | | |,|-|-|-|+|-|-|-|-|.|}} | |||
{{familytree | | E01 | | | | | | | | E02 | | E03 | | | E04 |E01=E01|E02=E02|E03=E03|E04=E04}} | |||
{{familytree | | | | | | | | | | | | |!| | | |!| | | | |!| | }} | |||
{{familytree | | | | | | | | | | | | F01 | | F02 | | | F03 |F01=F01|F02=F02|F03=F03}} | |||
{{familytree/end}} | |||
==References== | ==References== | ||
Revision as of 16:02, 18 August 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
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
OR
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
There are no established criteria for the diagnosis of [disease name].
Diagnostic Criteria
- The classical diagnosis of insulinoma is based on the Whipple's triad(1935)[1], which includes:
- Hypoglycemia( fasting blood glucose <50 mg/dL)
- Symptoms of hypoglycemia[2][3]
- Neuroglycopenic- visual disturbances(blurring of vision, diplopia), confusion, weakness, behavioral changes, seizures and coma
- Adrenergic-Sweating, palpitations, tremors and hyperphagia/obesity
- Improvement of symptoms after glucose infusion
- The diagnosis of insulinoma is based on the Biochemical assay with RadioImmunoAssay(RIA) and immunochemiluminescent assay(ICMA) in the abscence of plasma sulfonylureas (or drug causing hypoglycemia)[4][5]
- Insulin level >6uU/mL(43p mol/L by RIA and ≥3uU/ml by ICMA
- Glucose level <2.5mmol/L(45 mg/dL)
- C-peptide level ≥200 pmol/L
- Pronsulin level ≥25% or ≥22pmol/L is included in some criteria also
- The gold standard for diagnosis classically had been 72 hour fasting test[5][4]
- 33% patients develop symptoms in 12 hours, 80% at 24 hours, 90% after 48 hours and 100% after 72 hours of fasting.
| Suspicion of Insulinoma | |||||||||||||||||||||||||||||||||||||||||||||||
| Whipple's triad confirmed | |||||||||||||||||||||||||||||||||||||||||||||||
| 72 hour fast | |||||||||||||||||||||||||||||||||||||||||||||||
| Positive | Negative | ||||||||||||||||||||||||||||||||||||||||||||||
| D01' D01 | D02' D02 | ||||||||||||||||||||||||||||||||||||||||||||||
| E01 | E02 | E03 | E04 | ||||||||||||||||||||||||||||||||||||||||||||
| F01 | F02 | F03 | |||||||||||||||||||||||||||||||||||||||||||||
References
- ↑ Whipple AO, Frantz VK (1935). "ADENOMA OF ISLET CELLS WITH HYPERINSULINISM: A REVIEW". Ann. Surg. 101 (6): 1299–335. PMC 1390871. PMID 17856569.
- ↑ Metz DC, Jensen RT (2008). "Gastrointestinal neuroendocrine tumors: pancreatic endocrine tumors". Gastroenterology. 135 (5): 1469–92. doi:10.1053/j.gastro.2008.05.047. PMC 2612755. PMID 18703061.
- ↑ Boukhman MP, Karam JH, Shaver J, Siperstein AE, Duh QY, Clark OH (1998). "Insulinoma--experience from 1950 to 1995". West J Med. 169 (2): 98–104. PMC 1305178. PMID 9735690.
- ↑ 4.0 4.1 Metz, David C.; Jensen, Robert T. (2008). "Gastrointestinal Neuroendocrine Tumors: Pancreatic Endocrine Tumors". Gastroenterology. 135 (5): 1469–1492. doi:10.1053/j.gastro.2008.05.047. ISSN 0016-5085.
- ↑ 5.0 5.1 Grant CS (2005). "Insulinoma". Best Pract Res Clin Gastroenterol. 19 (5): 783–98. doi:10.1016/j.bpg.2005.05.008. PMID 16253900.