Management of Insulinoma
Insulinomas are functional neuroendocrine tumors resulting in excessive secretion of insulin. The classic presentation includes symptoms related to hypoglycemia which resolves with glucose administration. Symptoms usually occur after periods of fasting. Roughly 5% are associated with multiple endocrine neoplasia type 1 (MEN1) syndrome. Diagnosis is confirmed with a 72-h fasting test. Once a biochemical diagnosis is confirmed, localization with cross-sectional imaging should be obtained. If computed tomography (CT) or magnetic resonance imaging (MRI) fails to localize the tumor, endoscopic ultrasound may be employed. Definitive treatment with surgical resection is indicated when the patient does not have evidence of metastatic disease. Metastatic disease is usually treated medically with diazoxide and calcium channel blockers.
KeywordsWhipple’s triad Hypoglycemia Insulin Proinsulin C-peptide Calcium Arteriography
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