Insulinoma diagnostic criteria: Difference between revisions
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{{familytree/start}}'''Algorithm used commonly''' {{familytree | | | | | | | | | | | | A01 | | | | | |A01=Suspicion of Insulinoma}} | {{familytree/start}}'''Algorithm used commonly<ref name="pmid26742109">{{cite journal |vauthors=Falconi M, Eriksson B, Kaltsas G, Bartsch DK, Capdevila J, Caplin M, Kos-Kudla B, Kwekkeboom D, Rindi G, Klöppel G, Reed N, Kianmanesh R, Jensen RT |title=ENETS Consensus Guidelines Update for the Management of Patients with Functional Pancreatic Neuroendocrine Tumors and Non-Functional Pancreatic Neuroendocrine Tumors |journal=Neuroendocrinology |volume=103 |issue=2 |pages=153–71 |year=2016 |pmid=26742109 |pmc=4849884 |doi=10.1159/000443171 |url=}}</ref>''' {{familytree | | | | | | | | | | | | A01 | | | | | |A01=Suspicion of Insulinoma}} | ||
{{familytree | | | | | | | | | | | | |!| | | | | | | | }} | {{familytree | | | | | | | | | | | | |!| | | | | | | | }} | ||
{{familytree | | | | | | | | | | | | B01 | | | | | |B01=Whipple's triad confirmed}} | {{familytree | | | | | | | | | | | | B01 | | | | | |B01=Whipple's triad confirmed}} | ||
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{{familytree | | | F01 | |F02| |F03| | | |F04| | | |F05|F01=No visible lesion|F02=Visible<br>lesion(s)|F03=Unresectable<br>liver metastasis|F04=No<br>hypoglycemia|F05=Hypoglycemia}} | {{familytree | | | F01 | |F02| |F03| | | |F04| | | |F05|F01=No visible lesion|F02=Visible<br>lesion(s)|F03=Unresectable<br>liver metastasis|F04=No<br>hypoglycemia|F05=Hypoglycemia}} | ||
{{familytree | | | | |!| | |!| | | |!| | | | | |!| | | | | |!| | | | |}} | {{familytree | | | | |!| | |!| | | |!| | | | | |!| | | | | |!| | | | |}} | ||
{{familytree | | | | |!| | |!| | | |! | {{familytree | | | | |!| | |!| | | |!| | | | |G01| | | |G02| |G01=No follow up|G02=Differential diagnosis of<br> postprandial hypoglycemia}} | ||
{{familytree | | | |H01| |!| | |H03|H01=EUS|H03=Treat metastatic disease}} | {{familytree | | | |H01| |!| | |H03|H01=EUS|H03=Treat metastatic disease}} | ||
{{familytree | | | | |!| | |!| | |}} | {{familytree | | | | |!| | |!| | |}} | ||
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{{familytree | | | | | | | | | | | |O01|O01=Excision based on ASVS|}} | {{familytree | | | | | | | | | | | |O01|O01=Excision based on ASVS|}} | ||
{{familytree/end}} | {{familytree/end}} | ||
Abbreviations: EUS:Endoscopic Ultrasound,ASVS: Arterial stimulation Venous Sampling,GLP-1: Glucagon-like-peptide 1,OGTT: Oral Glucose Tolerance test | |||
==References== | ==References== | ||
Revision as of 20:16, 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 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 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) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Single lesion(s) | Multiple lesion(s) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Excision | ASVS | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Excision based on ASVS | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Abbreviations: EUS:Endoscopic Ultrasound,ASVS: Arterial stimulation Venous Sampling,GLP-1: Glucagon-like-peptide 1,OGTT: Oral Glucose Tolerance test
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.
- ↑ Falconi M, Eriksson B, Kaltsas G, Bartsch DK, Capdevila J, Caplin M, Kos-Kudla B, Kwekkeboom D, Rindi G, Klöppel G, Reed N, Kianmanesh R, Jensen RT (2016). "ENETS Consensus Guidelines Update for the Management of Patients with Functional Pancreatic Neuroendocrine Tumors and Non-Functional Pancreatic Neuroendocrine Tumors". Neuroendocrinology. 103 (2): 153–71. doi:10.1159/000443171. PMC 4849884. PMID 26742109.