Insulinoma differential diagnosis

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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

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
	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		>3	≥5	≤2.7	>25	-	-
Autoimmune Insulin	<50	↓		>>5	≤2.7	>25	-	+
Oral hypoglycemic agent	<50			≥5	≤2.7	>25	+	-	-	-
Normal/Fasting	<50		<3/20.8	<5	>2.7	<25	-	-

† PGPH= Post Gastric Bypass Hypoglycemia