Insulinoma – Diagnosis and Treatment
نویسندگان
چکیده
1.1 Epidemiology and basic characteristics Endogenous hyperinsulinism is characterized by repeated hypoglycemic episodes caused by autonomous hypersecretion of insulin produced by adenoma or multiple microadenomatosis originating in the beta-cells of the pancreas. The process is either localized into one or less frequently few solid tumors or is more diffuse within the islets of Langerhans. Endogenous hyperinsulinism is not regulated by plasma glucose and therefore clinical signs of hypoglycemia manifest whenever during the day. The term „organic hyperinsulinism“ is sometimes used showing that real endocrine pancreatic disease may be present in comparison with „functional hyperinsulinism“ characterized by reactive changes in a consequence of eating habits. Insulinoma (ICD-08151/1, ICD-08151/3) together with gastrinoma, VIPoma, somatostatinoma, glucagonoma and PPoma are members of nesidioma family which are recognized as neuroendocrine tumors of the pancreas. Some of them produce one hormone only and may therefore cause typical clinical symptoms. However, combined production of hormones may be also found and clinical diagnosis could be difficult when different symptoms would be combined. Positive but weak staining for gastrin or other hormones besides insulin may be sometimes present without any symptoms. On the other hand, neuroendocrine tumor in the pancreas can be described by histological examination in patients without typical clinical symptoms and malignant tumors are then confirmed. Insulinoma has incidence of 0.05-0.1 cases per 100 000 inhabitants in the Czech Republic (Škrha, 2001) but slightly more (0.4 per 100 000) has been described at the Mayo clinic register (Service et al., 1991). Data may depend on the database availability in different countries. It is predominantly present in women as compared to men. The proportion of insulinoma was around 60 % in women at Mayo clinic whereas our register involves 75 % of women (Service et al., 1991, Škrha et al., 2009). Insulin-producing tumors occur in more than 50 % of neuroendocrine tumors of the pancreas followed by gastrinomas in 30 %, VIPomas in 10-15 % and by others in less than 10 % (Perry & Vinik, 1995).
منابع مشابه
Insulin-producing Tumors and Introduction of a Case of Insulinoma
A cuse with single tenign insulinoma which was located in trc tail af pancreas is presented. It should be pinte out that a diagnosis of organic hypeinsulini::m may be difficult lo establish because of the aljpictl symptoms and signs. Whipple triad. laboratory, angiographv are important for diagnsis. Tle treatment of choice is early surgery with removal Df insulinoma. However if no tumor is fou...
متن کاملDiagnosis and management of hypoglycaemia due to pancreatic insulin-secreting neoplasia in a German shepherd dog
A 7-year-old castrated male German shepherd dog was presented with a 10-day history of intermittent lethargy, weakness and episodic seizures. Laboratory findings after admission revealed hypoglycaemia and hyperinsulinaemia. Provisional diagnosis of insulinoma was made based on the presence of concurrent hypoglycaemia and elevated insulin level. In exploratory laparotomy a small nodular mass was...
متن کاملAssociation of Insulinoma and Type 2 Diabetes Mellitus
The association of diabetes mellitus and insulinoma is unusual. We are reporting the case of a 58 years old patient having diabetes mellitus type 2 for several years. This patient was well balanced with oral anti-diabetic treatment. However, the diagnosis of insulinoma was discussed due to recent episodes of hypoglycemia that persisted even after stopping the treatment. Abdominal CT allowed the...
متن کاملDiagnosis and Treatment of Insulinomas in the Adults
Insulinomas are rare endocrine tumours developed from pancreatic beta cells. Their incidence is about 1 in 250,000 patient-years (Cryer 2008) (0.396 per 100,000 person-years for two decades, 1967-1986) (Service et al. 1991). The median age at surgical diagnosis was found to be 47 years (8 to 82), 59% being female patients. In a series of 33 patients, the age at the time of diagnosis was 57 +/16...
متن کاملInsulinoma in childhood.
Hypoglycaemia is an important cause of cerebral damage in childhood. While much attention has recently been directed to its detection and treatment in the neonatal period, in later childhood the diagnosis is often delayed. There are many possible causes of hypoglycaemia in childhood, but in only a minority of cases is a precise diagnosis made, the majority being labelled 'idiopathic'. An insuli...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
دوره شماره
صفحات -
تاریخ انتشار 2012