Insulinoma

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    • Insulinoma
      • Most common islet cell tumor. (MCQ)
      • Eighty-five percent are benign. (MCQ)
      • Most are solitary lesions. (MCQ)
      • Found with equal frequency in head, body, and tail of pancreas. (MCQ)
      • Signs and symptoms
        • “Spells” or blackouts due to hypoglycemia
        • Aggressiveness, confusion, coma
        • Insulinoma is characterized by Whipple’s triad: (MCQ)
          • Symptoms of hypoglycemia with fasting
          • Glucose < 50
          • Relief of symptoms with glucose
      • Differential diagnosis
        • Obesity
        • Surreptitious insulin administration
        • Circulating insulin antibodies
        • Renal insufficiency
      • Diagnosis
        • Fasting serum insulin level > 25 uU/mL (normal: < 15 uU/mL) (MCQ)
      • Treatment
        • Surgical resection is usually curative. (MCQ)
        • Diazoxide can improve hypoglycemic symptoms.
    • Gastrinoma
      • Also known as Zollinger–Ellison syndrome
      • Second most frequent islet cell tumor
      • 50% found in tail of pancreas
      • Small, slow-growing, multiple
      • 60% malignant(MCQ)
      • Tumor most commonly located in pancreatic head (70%) or duodenal bulb (10%)(MCQ)
      • Signs and symptoms
        • Signs of peptic ulcer disease
        • Epigastric pain most prominent after eating(MCQ)
        • Occasionally diarrhea
      • Differential diagnosis(MCQ)
        • Achlorhydria (pernicious anemia atrophic gastritis)
        • Pharmacologic inhibition of gastric acid secretion
          • proton pump inhibitors
          • H2-receptor blockers
        • Vagotomy with retained antrum
        • Antral G-cell hyperplasia
        • Renal insufficiency
      • Diagnosis
        • Fasting serum gastrin level > 500 pg/mL (normal: < 100 pg/mL) (MCQ)
      • Treatment
        • Proton pump inhibitor to alleviate symptoms(MCQ)
        • Surgical resection (difficult because lesions are usually multiple)
    • VIPoma
      • Overproduction of vasoactive intestinal peptide (VIP).
      • Also known as Verner–Morrison syndrome or WDHA syndrome: (MCQ)
        • Watery diarrhea,
        • Hypokalemia
        • Achlorhydria.
      • Most are malignant
      • majority have metastasized to liver at time of diagnosis.
      • Signs and symptoms (MCQ)
        • Severe watery diarrhea
        • Signs of hypokalemia
      • Diagnosis
        • Fasting serum VIP level > 800 pg/mL (normal: < 200 pg/mL) (MCQ)
      • Treatment
        • Surgical resection, chemotherapy
        • Octreotide (somatostatin analogue)
    • Glucagonoma
      • Most are malignant
      • large primary tumors usually metastasize to lymph nodes and liver at the time of diagnosis.
      • Signs and symptoms(MCQ)
        • Hyperglycemia
        • Anemia
        • Mucositis
        • Weight loss
        • Severe dermatitis
      • Differential diagnosis (MCQ)
        • Hepatic insufficiency
        • Severe stress
        • Hypoglycemia
        • Starvation
        • Decompensated diabetes mellitus
        • Renal insufficiency
      • Diagnosis
        • Fasting serum glucagon level > 1,000 pg/mL (normal: < 200 pg/mL) (MCQ)
      • Treatment
        • Surgery and chemotherapy.
    • Somatostatinoma
      • Very rare tumor.
      • Tumor is large and has metastasized at the time of diagnosis.
      • Signs and symptoms
        • Indigestion
        • Diarrhea
        • Abdominal cramps
        • Weight loss
        • Glucose intolerance/diabetes
        • Gallstones
        • Hypochlorhydria
      • Diagnosis
        • Fasting serum somatostatin level > 1,000 pg/mL (normal: < 100 pg/mL) (MCQ)
      • Treatment
        • Surgical resection, chemotherapy.
    • Clinical Pearls :
      • Clinical Vignette in MD Entrance:
        • A 34- year-old male complains of feeling faint and confused most notably after he exercises. (MCQ)
        • His symptoms improve after he has a soft drink
        • Diagnosis:  Insulinomacheck fasting serum insulin level.
        • Twenty-five percent of gastrinomas are associated with multiple endocrine neoplasia type 1 (MEN-1).
      • Clinical Vignette in MD Entrance:
        • A 46- year-old male  from Chattisgarh complains of chronic epigastric pain shortly following meals and notices needing increasing doses of his anti-ulcer medication. (MCQ)
        • Diagnosis:  Gastrinoma.
      • Clinical Vignette in MD Entrance:
        • A 62 year-old male from Patna presents with a history of severe watery diarrhea characterized by hypokalemia and achlorhydria (MCQ)
        • His most recent bout required fluid resuscitation when admitted in Hospital
        • Diagnosis:  VIPoma.
      • Necrolytic migratory erythema is the skin condition associated with glucagonoma. (MCQ)
      • Islet cell tumor cancer vaccines, use the patient’s own live cancer cells to induce remission or fight relapse(MCQ)


    Insulinoma pancreático – Enucleación laparoscópica
    USMLE: Medical video Lecture on insulinoma, sulfonylureas, exogenous insulin By UsmleTeam
    Prepare for USMLE examinations with us. Understand the basics, concepts and how to answer wisely and score 99 in each step
    Histopathology Pancreas –Islet cell tumor (insulinoma)
    Histopathology Pancreas –Islet cell tumor (insulinoma)
    Diagnosis of Insulinoma by EUS
    Girl, 16 y-old with multiple episodes of hypoglycemia, mental confusion and poor performance at school over the past two years. During the attacks were carried out numerous exams as US (2), CT (2) and MRI (3). All imaging studies were normal. Indicated EUS to identify suspected pancreatic gland tumo
    Dr Tomas Infernuso- Insulinoma
    12 year old dog with hypoglycemia secondary to an insulinoma. The left pacreatic mass was diagnosed on an abdominal ultrasound. After a left partial pancreatectomy the tumor came back as insulinoma. *Precise ligasure* was used to perform the surgery. The patient is currently doing well.
    Laparoscopic Resection of a Pancreatic Insulinoma
    This video demonstrates the Laparoscopic resection of a Pancreatic Insulinoma.
    Laparoscopic Enculeation of Insulinoma
    The Mount Sinai Metabolic, Endocrine and Minimally Invasive Surgery program presents a video of laparoscopic enucleation of an insulinoma that was performed by Dr. William B. Inabnet III, Chief of the Division of MEMIS and Professor of Surgery.
    Laparoscopic Resection of a Pancreatic Insulinoma with Intraoperative Ultrasound
    Laparoscopic Enucleation of a Pancreatic Insulinoma & Laparoscopic Instraluminal Pancreatic Cyst
    laparoscopic enucleation of pancreatic insulinoma
    We enucleated an insulinoma which was located at the corpus of the pancreas. The postoperative course was uneventful and patient was discharged without any complication.