Insulinoma: Difference between revisions
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==Treatment== | ==Treatment== | ||
[[Insulinoma medical therapy|Medical therapy]] | [[Insulinoma surgery|Surgical options]] | [[Insulinoma primary prevention|Primary prevention]] | [[Insulinoma secondary prevention|Secondary prevention]] | [[Insulinoma cost-effectiveness of therapy|Financial costs]] | [[Insulinoma future or investigational therapies|Future therapies]] | [[Insulinoma medical therapy|Medical therapy]] | [[Insulinoma surgery|Surgical options]] | [[Insulinoma primary prevention|Primary prevention]] | [[Insulinoma secondary prevention|Secondary prevention]] | [[Insulinoma cost-effectiveness of therapy|Financial costs]] | [[Insulinoma future or investigational therapies|Future therapies]] | ||
===Suppression tests=== | ===Suppression tests=== | ||
Revision as of 14:59, 17 January 2012
For patient information click here
| 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]
Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
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
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 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.
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
Template:Tumor morphology de:Insulinom he:אינסולינומה nl:Insulinoom fi:Insulinooma