Insulinoma: Difference between revisions

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VisualWikitext

Latest revision as of 22:38, 30 May 2019

For patient information click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]

Synonyms and keywords: Pancreatic beta cell tumor; tumor of beta cells; beta cell tumor; cancer of beta cells

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Insulinoma from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Treatment

Case Studies

Case #1

Related Chapters

Template:Tumor morphology de:Insulinom he:אינסולינומה nl:Insulinoom fi:Insulinooma

Template:WikiDoc Sources

@@ Line 1: / Line 1: @@
+__NOTOC__
+{{Insulinoma}}
 '''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
-{{Infobox_Disease |
+{{CMG}}; {{AE}}{{ADS}}
-  Name           = {{PAGENAME}} |
-  Image          = Pancreatic insulinoma (2).jpg |
-  Caption        = Histopathology of pancreatic endocrine tumor (insulinoma). |
-  DiseasesDB     = 6830 |
-  ICD10          = {{ICD10|C|25|4|c|15}}, {{ICD10|D|13|7|d|10}} |
-  ICD9           = {{ICD9|157.4}}, {{ICD9|211.7}} |
-  ICDO           = 8151 |
-  OMIM           = |
-  MedlinePlus    = |
-  MeshID         = D007340 |
-}}
-{{Insulinoma}}
-{{CMG}}
-__NOTOC__
-{{Editor Help}}
+{{SK}} Pancreatic beta cell tumor; tumor of beta cells; beta cell tumor; cancer of beta cells
 ==[[Insulinoma overview|Overview]]==
 ==[[Insulinoma historical perspective|Historical Perspective]]==
+==[[Insulinoma classification|Classification]]==
 ==[[Insulinoma pathophysiology|Pathophysiology]]==
-==[[Insulinoma epidemiology and demographics|Epidemiology & Demographics]]==
+==[[Insulinoma causes|Causes]]==
+==[[Insulinoma differential diagnosis|Differentiating Insulinoma from other Diseases]]==
+==[[Insulinoma epidemiology and demographics|Epidemiology and Demographics]]==
 ==[[Insulinoma risk factors|Risk Factors]]==
@@ Line 30: / Line 25: @@
 ==[[Insulinoma screening|Screening]]==
-==[[Insulinoma causes|Causes]]==
+==[[Insulinoma natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
-==[[Insulinoma differential diagnosis|Differentiating Insulinoma]]==
-==[[Insulinoma natural history|Complications & Prognosis]]==
 ==Diagnosis==
-===Signs and Symptoms===
+[[Insulinoma staging|Staging]] | [[Insulinoma history and symptoms|History and Symptoms]] | [[Insulinoma physical examination|Physical Examination]] | [[Insulinoma laboratory tests|Laboratory Findings]] | [[Insulinoma CT|CT]] | [[Insulinoma MRI|MRI]] | [[Insulinoma ultrasound|Ultrasound]] | [[Insulinoma other imaging findings|Other Imaging Findings]] | [[Insulinoma other diagnostic studies|Other Diagnostic Studies]]
-Patients with insulinomas usually develop neuroglycopenic symptoms.  These include recurrent headache, lethargy, [[diplopia]], and blurred vision, particularly with exercise or fasting.  Severe hypoglycemia may result in [[seizure]]s, [[coma]], and permanent neurological damage.  Symptoms resulting from the catecholaminergic response to hypoglycemia (i.e. tremulousness, palpitations, [[tachycardia]], sweating, hunger, anxiety, nausea) are not as common.  Sudden weight gain (the patient can become massively obese) is sometimes seen.
-===Lab Tests===
-The diagnosis of insulinoma is suspected in a patient with symptomatic fasting hypoglycemia.  The conditions of [[Whipple’s triad]] need to be met for the diagnosis of "true hypoglycemia" to be made:<br/>
-:1. symptoms and signs of hypoglycemia,<br/>
-:2. concomitant plasma glucose level of 45 mg/dL (2.5 mmol/L) or less, and<br/>
-:3. reversibility of symptoms with administration of glucose.<br/>
-===Blood tests===
-The following blood tests are needed to diagnose insulinoma:<br/>
-*glucose<br/>
-*insulin<br/>
-*C-peptide<br/><br/>
-If available, a [[proinsulin]] level might be useful as well.  Other blood tests may help rule out other conditions which can cause hypoglycemia.
-===Suppression tests===
-Normally, endogenous insulin production is suppressed in the setting of hypoglycemia.  A 72-hour fast, usually supervised in a hospital setting, can be done to see if insulin levels fail to suppress, which is a strong indicator of the presence of an insulin-secreting tumour.
-:During the test, the patient may have calorie-free and caffeine-free liquids.  Capillary blood glucose is measured every 4 hours using a [[glucose meter|reflectance meter]], until values < 60 mg/dL (3.3 mmol/L) are obtained. Then, the frequency of blood glucose measurement is increased to every hour until values are < 49 mg/dL (2.7 mmol/L).  At that point, or when the patient has symptoms of hypoglycemia, a blood test is drawn for serum glucose, insulin, proinsulin, and C-peptide levels.  The fast is stopped at that point, and the hypoglycemia treated with intravenous dextrose or calorie-containing food or drink.<br/>
-===Diagnostic imaging===
-The insulinoma might be localized by non-invasive means, using [[ultrasound]], [[CT scan]], or by [[MRI]] techniques.<br/>
-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.<br/>
-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]]).<br>
+[[Insulinoma medical therapy|Medical Therapy]] | [[Insulinoma surgery|Surgery]] | [[Insulinoma primary prevention|Primary Prevention]]  | [[Insulinoma secondary prevention|Secondary Prevention]] | [[Insulinoma cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Insulinoma future or investigational therapies|Future or Investigational Therapies]]
-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.<br/>
-[[Streptozotocin]] is used in [[islet cell carcinoma]]s which produce excessive insulin.  Combination [[chemotherapy]] is used: either [[doxorubicin]] + streptozotocin, or [[fluorouracil]] + streptotozocin in patients where doxorubicin is contraindicated.[http://www.cancer.gov/cancertopics/pdq/treatment/isletcell/HealthProfessional/page6] <br>
-In metastasizing tumours with intrahepatic growth, [[hepatic artery|hepatic arterial]] occlusion or [[embolization]] can be used. [http://www.nci.nih.gov/cancertopics/pdq/treatment/isletcell/Patient/page5]
-==Prognosis==
+==Case Studies==
-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.
+[[Case study one|Case #1]]
-==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==
-*[[hypoglycemia]]
-*[[causes of hypoglycemia]]
-*[[pancreas]]</br>
-==External links==
-*[http://www.endotext.org/guthormones/guthormone4/guthormoneframe4.htm www.endotext.org article]
+==Related Chapters==
+*[[Hypoglycemia]]
+*[[Causes of hypoglycemia]]
+*[[Pancreas]]
 {{Tumor morphology}}
 [[de:Insulinom]]
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 [[Category:Disease]]
+[[Category:Medicine]]
 [[Category:Endocrinology]]
 [[Category:Oncology]]
 [[Category:Mature chapter]]
+ [[Category:Up-To-Date]]
+[[Category:Oncology]]
+[[Category:Medicine]]
+[[Category:Gastroenterology]]
+[[Category:Surgery]]