Insulinoma differential diagnosis: Difference between revisions

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Revision as of 15:59, 28 August 2017

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 palpitations, profuse sweating, dizziness, such as [differential dx1], [differential dx2], and [differential dx3].

OR

Insulinoma must be differentiated from the exogenous use of insulin, drugs causing hypoglycemia like sulfonylureas.

Differentiating insulinoma from other Diseases

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].

As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].

Preferred Table for differentials for Hypoglycemia

Diagnoses	Laboratory Findings differentiating among causes of Hypoglycemia
Diagnoses	S.Glucose (mg/dL)/(mmol/L)	C Peptide (pmol/L)	S.Insulin (μU/mL)/(pmol/L)	S.Proinsulin (pmol/L)	S. Beta hydroxybutyrate	Glucose increase after glucagon(mg/dL)	Oral Hypoglycemic agent	Antibodies to Insulin
Exogenous Insulin	<55/2.5	<200	>>3	<5	≤2.7	>25	-	-
Insulinoma/Nesidioblastosis/PGPH†	<55	≥200	>3	≥5	≤2.7	>25	-	-
Autoimmune Insulin	<55	>>200‡		>>5	≤2.7	>25	-	+
Oral hypoglycemic agent	<55	≥200		≥5	≤2.7	>25	+	-
Normal/Fasting	<55	<200	<3/20.8	<5	>2.7	<25	-	-

† PGPH= Post Gastric Bypass Hypoglycemia  ‡

Free C-peptide and proinsulin concentrations are low

Free C-peptide and proinsulin concentrations are low Free C-peptide and proinsulin concentrations are low

References

Template:WH Template:WS

@@ Line 43: / Line 43: @@
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Insulinoma]]/[[Nesidioblastosis]]/PGPH†
 | style="background: #F5F5F5; padding: 5px;text-align: center;" |<55
-| style="background: #F5F5F5; padding: 5px;text-align: center;" |
+| style="background: #F5F5F5; padding: 5px;text-align: center;" |≥200
-| style="background: #F5F5F5; padding: 5px;text-align: center;"|>3
+| style="background: #F5F5F5; padding: 5px;text-align: center;" |>3
 | style="background: #F5F5F5; padding: 5px;text-align: center;" |≥5
 | style="background: #F5F5F5; padding: 5px;text-align: center;" |≤2.7
@@ Line 52: / Line 52: @@
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |Autoimmune Insulin
-| style="background: #F5F5F5; padding: 5px;text-align: center;" |<50
+| style="background: #F5F5F5; padding: 5px;text-align: center;" |<55
-| style="background: #F5F5F5; padding: 5px;text-align: center;" |↓
+| style="background: #F5F5F5; padding: 5px;text-align: center;" |>>200‡
 | style="background: #F5F5F5; padding: 5px;text-align: center;" |
 | style="background: #F5F5F5; padding: 5px;text-align: center;" |>>5
@@ Line 62: / Line 62: @@
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |Oral hypoglycemic agent
-| style="background: #F5F5F5; padding: 5px;text-align: center;" |<50
+| style="background: #F5F5F5; padding: 5px;text-align: center;" |<55
-| style="background: #F5F5F5; padding: 5px;text-align: center;" |
+| style="background: #F5F5F5; padding: 5px;text-align: center;" |≥200
 | style="background: #F5F5F5; padding: 5px;text-align: center;" |
 | style="background: #F5F5F5; padding: 5px;text-align: center;" |≥5
@@ Line 72: / Line 72: @@
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |Normal/Fasting
-| style="background: #F5F5F5; padding: 5px;text-align: center;" |<50
+| style="background: #F5F5F5; padding: 5px;text-align: center;" |<55
-| style="background: #F5F5F5; padding: 5px;text-align: center;" |
+| style="background: #F5F5F5; padding: 5px;text-align: center;" |<200
 | style="background: #F5F5F5; padding: 5px;text-align: center;" |<3/20.8
 | style="background: #F5F5F5; padding: 5px;text-align: center;" |<5
@@ Line 82: / Line 82: @@
 |}
-  † PGPH= Post Gastric Bypass Hypoglycemia
+  † PGPH= Post Gastric Bypass Hypoglycemia  ‡
+ Free C-peptide and proinsulin concentrations are low
+Free C-peptide and proinsulin concentrations are low
+Free C-peptide and proinsulin concentrations are low
 ==References==