National Cancer Institute®
Last Modified: November 21, 2001
UI - 20452441
AU - Hirshberg B; Livi A; Bartlett DL; Libutti SK; Alexander HR; Doppman JL;
TI - Skarulis MC; Gorden P Forty-eight-hour fast: the diagnostic test for insulinoma.
SO - J Clin Endocrinol Metab 2000 Sep;85(9):3222-6
AD - Division of Intramural Research, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA.
Insulinoma causes fasting hypoglycemia due to inappropriate insulin secretion. Its diagnosis is based on demonstrating Whipple's triad during a supervised 72-h fast. For 75 yr, the 72-h fast has been the cornerstone for the diagnosis; however, it has never been critically assessed using newer assays for insulin, C peptide, and proinsulin. Thus, the aim of the current study is to assess the need for a full 72-h fast for the diagnosis of insulinoma. Patients with suspected hypoglycemia with documented glucose concentrations below 45 mg/dL were admitted to the NIH. Data obtained during the supervised fast of patients with pathologically proven insulinoma over a 30-yr period (1970-2000) were reviewed. We identified 127 patients with insulinoma. The average age of patients was 42.7 +/- 15.9 yr, with a predominance of females (62%). 107 patients had a benign tumor, 20 had malignant insulinoma, and 15 patients had multiple endocrine neoplasia type 1. The fast was terminated due to hypoglycemia in 44 patients (42.5%) by 12 h, 85 patients (66.9%) by 24 h, and 120 (94.5%) by 48 h. Seven patients fasted beyond 48 h despite subtle neuroglycopenic symptoms and glucose and insulin concentrations diagnostic of insulinoma. Immunoreactive proinsulin was elevated at the beginning of the fast in 90% of 42 patients. Proinsulin in noninsulinoma, in contrast to insulinoma, patients is usually suppressible; therefore, samples taken in the suppressed state have the greatest diagnostic value. We conclude that with the current available insulin and proinsulin assays, the diagnosis of insulinoma can be made within 48 h. Thus, the 48-h fast should replace the 72-h fast in textbooks and hospital protocols as the new diagnostic standard.
UI - 21449417
AU - McCormick JD; Diguilio D; Adelman HM
TI - An obese man with anxiety, sweating, and headache.
SO - Hosp Pract (Off Ed) 2001 Sep 15;36(9):21-2
AD - University of South Florida, James A. Haley Veterans Hospital, Tampa, USA.
A 47-year-old man reported becoming confused, disoriented, and anxious while driving his car. He recalled sweating and having blurred vision, palpitations, and a diffuse headache shortly before pulling to the side of the road and losing consciousness. Emergency service personnel arrived about 15 minutes later and administered a 50% solution of dextrose intravenously. On regaining consciousness, the patient had no weakness,shortness of breath, chest pain, or loss of bowel or bladder function. He had experienced a similar episode one week earlier and several others in the distant past. Each time, symptoms had been alleviated by eating.
UI - 21271470
AU - Yeh CN; Chen MF; Chen TC
TI - Surgical treatment of pancreatic vasoactive intestinal polypeptide-secreting tumor: a case report.
SO - Hepatogastroenterology 2001 Mar-Apr;48(38):421-3
AD - Department of Surgery, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan. firstname.lastname@example.org
A 68-year-old woman presented with secretory watery diarrhea causing hypokalimia, hypoalbuminemia and dehydration for 5 years. Subsequent investigations including abdominal ultrasonography and computed tomography scanning revealed a mass measuring 7 x 6 cm in the pancreatic tail. The diagnosis of pancreatic VIPomas was suspected on the basis of clinical symptoms. The patient underwent distal pancreatectomy and splenectomy after resuscitation of electrolyte imbalance, dehydration and malnutrition. The pathological examination with histoimmunochemical stain confirmed the diagnosis. Postoperative course is uneventful and the patient does not have symptoms any longer during the follow-up period.
UI - 21284593
AU - Mizuno N; Naruse S; Kitagawa M; Ishiguro H; Ito O; Ko SB; Yoshikawa T;
TI - Tanahashi C; Ito M; Hayakawa T Insulinoma with subsequent association of Zollinger-Ellison syndrome.
SO - Intern Med 2001 May;40(5):386-90
AD - Department of Internal Medicine II, Nagoya University School of Medicine.
We report a patient with insulinoma associated with Zollinger-Ellison syndrome. A 67-year-old woman was first admitted to our hospital for an abdominal mass. Abdominal computed tomography (CT) revealed a large pancreatic tumor, which was then diagnosed as an unresectable pancreatic adenocarcinoma. At the age of 71, she presented symptoms of hypoglycemia. Fasting blood glucose was 21 mg/dl and plasma immunoreactive insulin level was 846 microU/ ml. Plasma gastrin, glucagon, vasoactive intestinal polypeptide and somatostatin levels were all normal. At the age of 73, hypoglycemic attacks occurred more frequently and she was admitted to our hospital. Abdominal CT scan showed multiple liver metastases. Chemotherapy with 5-fluorouracil and doxorubicin was performed. Three months later, she had an emergency laparotomy because of a perforated duodenal ulcer. Plasma gastrin level was 1,960 pg/ml at that time. Gastric hypersecretion was well controlled with a proton pump inhibitor (lansoprazole) but she died of widespread cancer dissemination 8 years after her first admission. On autopsy, histologic examination revealed a mixed acinar-endocrine carcinoma of the pancreas. Immunohistochemical stains were positive for insulin, gastrin, and alpha1-antitrypsin.
UI - 21450510
AU - Chatziioannou A; Kehagias D; Mourikis D; Antoniou A; Limouris G; Kaponis
TI - A; Kavatzas N; Tseleni S; Vlachos L Imaging and localization of pancreatic insulinomas.
SO - Clin Imaging 2001 Jul-Aug;25(4):275-83
AD - Department of Radiology, Areteion Hospital, University of Athens, 76 Vas. Sofias Street, Athens 11528, Greece.
For pancreatic insulinomas, the treatment of choice is surgical excision, which when successful is curative. Intraoperative palpation combined with ultrasonography theoretically depict almost all tumors, however the accuracy of palpation is improved by the preoperative localization. All recent advances in imaging have improved the likelihood for curative surgical resection. Our purpose is to demonstrate the characteristics of all modalities, which may be used in the preoperative localization algorithm.
UI - 21463170
AU - Ding H; Kudo M; Onda H; Nomura H; Haji S
TI - Sonographic diagnosis of pancreatic islet cell tumor: value of intermittent harmonic imaging.
SO - J Clin Ultrasound 2001 Sep;29(7):411-6
AD - Department of Gastroenterology and Hepatology, Kinki University School of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan.
We describe a case of nonfunctioning islet cell tumor of the pancreas diagnosed preoperatively by intermittent harmonic power Doppler imaging and digital subtraction gray-scale harmonic imaging and the use of the contrast agent SH U 508A (Levovist). Hypervascularity and tumor perfusion were clearly demonstrated with both harmonic imaging techniques in the early arterial phase. Sonographic findings were confirmed by other modalities and by histopathologic examination. Copyright 2001 John Wiley & Sons, Inc.
UI - 21410862
AU - Hasegawa K; Toyama H; Ito S; Ito T; Wakabayashi H; Hoshi S
TI - [Aged watery diarrhea, hypokalemia, achlorhydria (WDHA) syndrome]
SO - Nippon Naika Gakkai Zasshi 2001 Jul 10;90(7):1333-5
AD - Department of Internal Medicine, Takeda General Hospital, Aizuwakamatu.
UI - 21473977
AU - Brandle M; Pfammatter T; Spinas GA; Lehmann R; Schmid C
TI - Assessment of selective arterial calcium stimulation and hepatic venous sampling to localize insulin-secreting tumours.
SO - Clin Endocrinol (Oxf) 2001 Sep;55(3):357-62
AD - Division of Endocrinology and Diabetes, Department of Internal Medicine, University Hospital Zurich, Switzerland. email@example.com
OBJECTIVE: Non-invasive localization modalities such as ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) often fail to localize insulinomas smaller than 2 cm in diameter. Recent studies have shown that the selective arterial stimulation and hepatic venous sampling (ASVS) technique using intra-arterial calcium as the insulin secretagogue facilitates the regionalization of such occult insulinomas. This study assesses the sensitivity of ASVS in localizing insulin-secreting tumours. SUBJECTS AND METHODS: Eleven consecutive patients (8 women), aged 29-82 years, were studied over the past 4 years at our hospital. Hyperinsulinaemic hypoglycaemia due to an insulin-secreting tumour was proven in all patients. Calcium gluconate (0.025 mEq/kg body weight) was injected directly into the arteries supplying the pancreas and the liver. Insulin levels were measured in samples taken from the right hepatic vein before and 30, 60 and 120 s after each injection. The ASVS technique was performed in all 11 patients; the results were compared with the surgical findings in 10 patients and the autopsy findings in 1 case. The ASVS results were also compared with the findings of other, previously performed imaging modalities. RESULTS: ASVS correctly localized 4 insulin-secreting tumours to the head, 3 to the body, 1 to the tail, 2 to the tail or body of the pancreas and 1 to the liver. Thus, the sensitivity was 100% (11/11) whereas other localization techniques were less sensitive: 7/11 tumours were detected by angiography, 4/8 by endosonography, 3/8 by CT and 1/6 by MRI. Insulinomas (confirmed by histological examination), sized 4-25 mm, were found in 10 patients. All were cured by selective surgery and remained free of hypoglycaemia over the next 1-4 years of follow-up. An insulin-secreting neuroendocrine tumour in the liver was documented in 1 case at autopsy. CONCLUSIONS: Arterial stimulation and hepatic venous sampling is a very sensitive technique for preoperative localization of insulin-producing tumours. It can help to plan minimally invasive surgery and to select an appropriate strategy for patients suffering from malignant tumours in others.
UI - 21536441
AU - Nollet A; Bruyninckx F; Van Den Bruel A; Muls E; Bouillon R; Mathieu C
TI - Muscle fibre membrane instability in a young boy with an insulinoma.
SO - Clin Endocrinol (Oxf) 2001 Oct;55(4):559-61
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