Original ArticlesInsulinomaEndoscopic Ultrasonography - A Sensitive Tool in the Preoperative Localization of Insulinoma
Section snippets
INTRODUCTION
Most insulinomas are solitary, benign intrapancreatic tumors. As the current management strategy is to remove them with focused surgical dissection, preoperative localization is crucial(1). Currently, the most popular imaging modalities for anatomical localization are computerized tomography (CT) and magnetic resonance imaging (MRI). CT is usually the first choice as it is widely available. However, with the advent of more rapid contrast-enhanced multiphase image acquisition with breath-holding
METHODS
We analyzed the hospital records of all adult patients (age >18 years) diagnosed with an insulinoma between October 2004 and September 2010. Eighteen patients were diagnosed with insulinoma based on the clinical practice guidelines of the Endocrine Society (5). All patients underwent a supervised in-patient 72-hour fast that demonstrated low blood sugar and plasma glucose levels, corroborative symptoms, and concomitant elevations of insulin and C-peptide levels. C-peptide was measured in serum
RESULTS
Eighteen patients were diagnosed with an insulinoma between 2004 an 2010. The initial clinical features and laboratory parameters of all patients are shown in Table 1. The majority of patients were between 30 and 60 years old at presentation. The mean duration of symptoms prior to diagnosis was 30.2 months. The most common presenting symptom was hypoglycemia (66.9%), followed by loss of consciousness (61.1%), and seizures (44.4%). Weight gain occurred in 11 patients. The site of the pancreatic
DISCUSSION
Our results are comparable with one of the largest series published on insulinoma that described 10 years of data on 237 Mayo Clinic patients. Overall, 50% of our patients were females (57% in the Mayo Clinic series), and 70% had fasting hypoglycemia as the presenting symptom (73% in the Mayo Clinic series). We found that 67% of our patients had preoperative tumor localization (75% in the Mayo Clinic series) (7).
Hyperinsulinemic hypoglycemia was initially diagnosed by using the guidelines
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Cited by (17)
Multiple endocrine neoplasia type 1 (MEN-1) and neuroendocrine neoplasms (NENs)
2022, Seminars in Cancer BiologyCitation Excerpt :The next diagnostic step following the biochemical confirmation of hypoglycaemic hyperinsulinaemic syndrome in the absence of insulin antibodies, is localization of the tumour by abdominal ultrasound, contrast-enhanced endoscopic ultrasonography, CT or MRI scans, with sensitivities 70 %, 89 %, 83−95% and 95−100%, respectively [79,222,234–239]. Invasive radiological techniques like endoscopic ultrasonography (sensitivity: head, body, tail of the pancreas 93 %, 79 % and 40 %, respectively) and/or selective arterial calcium stimulation test with hepatic venous sampling (sensitivity up to 93 %) may be necessary [222,240–245]. Somatostatin receptor scintigraphy has limited value in the detection of benign insulinomas due to their low expression of somatostatin receptor type 2 (sensitivity: 50–60 %) [246–249].
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2017, AACE Clinical Case ReportsCitation Excerpt :Imaging should be obtained in cases where surreptitious intake and medication side effects have been ruled out. Abdominal ultrasound and CT scanning have similar sensitivity of approximately 70% for detection of insulinomas (11). Our patient had both tests completed, and neither was able to visualize a mass.
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