Insulinoma diagnostic criteria

Insulinoma Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Insulinoma from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Staging
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
X-ray
Ultrasound
CT
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Insulinoma diagnostic criteria On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Insulinoma diagnostic criteria All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Insulinoma diagnostic criteria
CDC on Insulinoma diagnostic criteria
Insulinoma diagnostic criteria in the news
Blogs on Insulinoma diagnostic criteria
Directions to Hospitals Treating Insulinoma
Risk calculators and risk factors for Insulinoma diagnostic criteria

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), which includes:

1. Hypoglycemia( fasting blood glucose <50 mg/dL)
2. Symptoms of hypoglycemia
   • Neuroglycopenic- visual disturbances(blurring of vision, diplopia), confusion, weakness, behavioral changes, seizures and coma
   • Adrenergic-Sweating, palpitations, tremors and hyperphagia/obesity
3. 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)
  • 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
  • 33% patients develop symptoms in 12 hours, 80% at 24 hours, 90% after 48 hours and 100% after 72 hours of fasting.

Algorithm used commonly

Suspicion of Insulinoma

Whipple's triad confirmed

72 hour fast

Positive

Negative

MRI/CT

Prolonged OGTT or mixed meal

No visible lesion

Visible lesion(s)

Unresectable liver metastasis

No hypoglycemia

Hypoglycemia

No follow up

Differential diagnosis of postprandial hypoglycemia

EUS

Treat metastatic disease

No visible lesion(s)

Visible lesion(s)

GLP-1 Scan or ASVS

No lesion(s)

Identified lesion(s)

Medical control and reevaluation

Surgical exploration (intraoperative US)