Insulinoma
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| Insulinoma | |
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| Histopathology of pancreatic endocrine tumor (insulinoma). | |
| ICD-10 | C25.4, D13.7 |
| ICD-9 | 157.4, 211.7 |
| ICD-O: | 8151 |
| DiseasesDB | 6830 |
| MeSH | D007340 |
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Insulinoma Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Insulinoma On the Web |
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American Roentgen Ray Society Images of Insulinoma |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Historical Perspective
Pathophysiology
Epidemiology & Demographics
Risk Factors
Screening
Causes
Differentiating Insulinoma
Complications & Prognosis
Diagnosis
History and Symptoms | Physical Examination | Staging | Laboratory tests | Electrocardiogram | X Rays | CT | MRI Echocardiography or Ultrasound | Other images | Alternative diagnostics
Treatment
Medical therapy | Surgical options | Primary prevention | Secondary prevention | Financial costs | Future therapies
Diagnostic imaging
The insulinoma might be localized by non-invasive means, using ultrasound, CT scan, or by MRI techniques.
Sometimes, angiography with percutaneous transhepatic pancreatic vein catheterization to sample the blood for insulin levels is required. Calcium can be injected into selected arteries to stimulate insulin release from various parts of the pancreas, which can be measured by sampling blood from their respective veins. The use of calcium stimulation improves the specificity of this test.
During surgery to remove an insulinoma, an intra-operative ultrasound can sometimes localize the tumour, which helps guide the surgeon in the operation.
Treatment
The definitive management is surgical removal of the insulinoma. This may involve removing part of the pancreas as well (Whipple procedure and distal pancreatectomy).
Medications such as diazoxide and somatostatin can be used to block the release of insulin for patients who are not surgical candidates or who otherwise have inoperable tumours.
Streptozotocin is used in islet cell carcinomas which produce excessive insulin. Combination chemotherapy is used: either doxorubicin + streptozotocin, or fluorouracil + streptotozocin in patients where doxorubicin is contraindicated.[3]
In metastasizing tumours with intrahepatic growth, hepatic arterial occlusion or embolization can be used. [4]
Prognosis
Most patients with benign insulinomas can be cured with surgery. Persistent or recurrent hypoglycemia after surgery tends to occur in patients with multiple tumours. About two percent of patients develop diabetes mellitus after their surgery.
History
Hypoglycemia was first recognized in the 19th century. In the 1920’s, after the discovery of insulin and its use in the treatment of diabetics, hyperinsulinism was suspected to be a cause of hypoglycemia in non-diabetics. The first report of a surgical cure of hypoglycemia by removing an islet cell tumour was in 1929.
See also
External links
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