To start of, what exactly is an insulinoma as it has not been covered so far in our textbooks? An insulinoma does have to do with insulin and it is a tumor. Insulinoma is a tumor most commonly located on the pancreas that causes insulin to be secreted in excess amounts. Generally, the first thought coming to mind when hearing tumor is cancer. However, 90% of those tumors are benign. They can cause major disruption in life however.
A common clinical sign, as the tumor causes an increase in insulin, is hypoglycemia. Such a tumor is thought to be the most common cause of hypoglycemia caused by an internal factor that cannot be attributed to an environmental factor such as diabetes mellitus type 2. A variety of test can be used to diagnose the insulinoma as the cause of hypoglycemia including a 72-hour fast that can detect most insulinomas. CT and MRI are common diagnostic studies used to detect the location of such a tumor. Such tumor are often times smaller than 2cm.
Surgery can treat insulinomas most often, there are however other options to manage such a tumor. Surgery is chosen for all localized, noninvasive tumors. Depending on the characteristics of the tumor such as size, location and type, different approaches of surgery are available. Removal of the tumor called enucleation, partial or middle pancreatectomy have the significant advance of preserving the essential pancreatic function which avoids the need for medication and endocrine management post-surgery.
A high rate of post-surgical fistulas have been associated with surgery. It is crucial for all members of the health care provider to assess and monitor for such complications as well as taking steps to avoid such a complication in the first place.
Magnetic resonance imaging of insulinoma of the pancreas. Insulinomas (arrows) generally demonstrate low signal intensity on T1-weighted images (A) and high signal intensity on T2-weighted images (B). Provided by: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3574879/figure/F2/
Good Afternoon Nora,
ReplyDeleteJust when we thought we knew all there was to know about insulin and the pancreas, you discover insulinomas! Who would have known. It is understandable that hypoglycemia would be one of the first clinical manifestations. I know you stated it is a leading internal cause of hypoglycemia, not related to environmental factors such as DMT2. I wonder though if there is a link between DM and the tumors. The imaging is great I wish I knew more about how to read radiological imagery. It is great that most non-invasive tumors can be removed surgically, sparing excess damage to the pancreas. In addition thanks for the tip on what to watch out for post-surgical. This would be a terrible thing to happen to anyone, however a 90% benign rate is better than most.
Any time the pancreas is mentioned in the same sentence as surgery, I always remember Ms. P, telling us how the pancreas is the "Lion of the Abdomen" and surgeons always want to stay away from it. Thanks for sharing a great article and review about a topic I never knew existed, I think it is cool when we can learn from one another.
Great job,
Shane Howard SN, FSCC