Insulinoma diagnostic criteria
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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) | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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.