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, These are classified on the basis of laboratory findings into exogenous insulin, oral hypoglycemic agents(e.g. sulphonylureas), nesidioblastosis, insulin autoimmune hypoglycemia.
Differentiating insulinoma from other Diseases
- Insulinoma must be differentiated from other diseases that cause features of hypoglycemia. These are classified on the basis of laboratory findings.
Differentials for Hypoglycemia on the basis of Laboratory findings[1]:
| 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 | |
| Normal/Fasting | <55 | <200 | <3/20.8 | <5 | >2.7 | <25 | - | - |
| Exogenous Insulin | <55/2.5 | <200 | >>3 | <5 | ≤2.7 | >25 | - | - |
| Insulinoma/Nesidioblastosis/PGPH† | <55 | ≥200 | ≥3 | ≥5 | ≤2.7 | >25 | - | - |
| Insulin Autoimmune hypoglycemia | <55 | >>200‡ | >>3 | >>5‡ | ≤2.7 | >25 | - | + |
| Oral hypoglycemic agent | <55 | ≥200 | ≥3 | ≥5 | ≤2.7 | >25 | + | - |
| IGF† | <55/2.5 | <200 | <3 | <5 | ≤2.7 | >25 | - | - |
† PGPH= Post Gastric Bypass Hypoglycemia, IGF= Insulin Growth Factor ‡ Free C-peptide and proinsulin concentrations are low
References
- ↑ Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER; et al. (2009). "Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline". J Clin Endocrinol Metab. 94 (3): 709–28. doi:10.1210/jc.2008-1410. PMID 19088155.