Diagnosis and treatment of ‘insulinoma’

Fajans, Stefan S.; Vinik, Aaron I.

doi:10.1007/978-1-4613-2849-0_11

Cited by 5 publications

(7 citation statements)

References 178 publications

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“…If this ratio is greater than 0.3, the diagnosis can usually be made within the first 24 hours of a 72-hour fast. Of our total insulinoma patients, nearly 90% could be diagnosed within the first 24 hours [9,15]. The only exception was a malignant insulinoma occurring in the MEN I patient discussed earlier.…”

Section: Insulinomasmentioning

confidence: 76%

“…Therefore, estimation of the percentage of proinsulin to insulin may be helpful in predicting the possibility of malignancy, especially when it exceeds 40%. Since 1960, the pro-insulin component exceeded 22% of the total fasting IRI in more than 80% of patients with proven tumors [9]. In patients with islet-cell carcinomas, an even higher proportion is usually found in the plasma.…”

Section: Insulinomasmentioning

confidence: 99%

“…Malignancy was demonstrated in 11% of insulinomas at the Mayo Clinic as determined by lymphatic or hepatic metastases or by perineural and/or vascular invasion [6]. Since 1960 we have treated 69 patients with proven hyperinsulinism at the University of Michigan [9]. Four of these patients (6%) were proven to have malignant insulinomas as determined by metastases to either lymph nodes or liver.…”

Section: Insulinomasmentioning

confidence: 99%

“…Since 1960 we have treated 69 patients with proven hyperinsulinism at the University of Michigan [9]. Four of these patients (6%) were proven to have malignant insulinomas as determined by metastases to either lymph nodes or liver.…”

Section: Insulinomasmentioning

confidence: 99%

“…Malignant islet-cell tumors that produce insulin can be treated by antihormonal therapy and/or antitumor therapy when surgical cure cannot be attained. It is clear that the development of diazoxide (Proglycem ~) represents a major therapeutic advance [9,15]. This drug directly inhibits release of insulin by the beta cells of the pancreas.…”

Section: Insulinomasmentioning

confidence: 99%

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Malignant islet‐cell tumors of the pancreas

Thompson

Eckhäuser

1984

World j. surg.

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Although malignant islet‐cell tumors are uncommon, they are an important group of pancreatic neoplasms because appropriate treatment can often result in effective palliation even though cure is infrequent. In general, these tumors are relatively slow growing so that a combination of surgical and chemotherapeutic measures may prove very beneficial. In some patients with tumors hypersecreting insulin, gastrin, glucagon, or vasoactive intestinal polypeptide (VIP), the hormonal effects of the neoplasm can be life‐threatening. Surgical treatment must, therefore, consider both the functional and malignant characteristics of the individual tumor. In many patients with functional tumors, surgical debulking of the primary tumor may be indicated even when a curative resection cannot be accomplished. Some malignancies may be cured by an appropriate pancreatic resection even when peripancreatic lymph nodes are already involved. Although a Whipple procedure is not indicated when hepatic metastases are present, this procedure may cure tumors localized to the pancreatic head and/or peripancreatic lymph nodes. Because hepatic metastases are usually multiple and involve both lobes, liver resections, other than wedge excisions of peripherally located functional metastases, are not indicated. Malignant nonfunctioning islet‐cell tumors are probably best treated with systemic or regional chemotherapy when metastatic. Surgical resections or bypass procedures may be infrequently useful in those cases in which the primary tumor causes either duodenal or bile duct obstruction. The most effective methods used to control hepatic metastases are systemic and hepatic arterial chemotherapy. An alternative is selective hepatic artery embolization. Recently, an implantable hepatic arterial infusion pump has been used with encouraging results in this group of patients. The chemotherapeutic agents that have been most effective in the treatment of hepatic metastases include streptozotocin, DTIC, and fluorouracil.

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Section: Insulinomasmentioning

confidence: 76%

Section: Insulinomasmentioning

confidence: 99%

Section: Insulinomasmentioning

confidence: 99%

Section: Insulinomasmentioning

confidence: 99%

Section: Insulinomasmentioning

confidence: 99%

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Malignant islet‐cell tumors of the pancreas

Thompson

Eckhäuser

1984

World j. surg.

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Plasma gut hormone levels in 37 patients with pheochromocytomas

1986

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Pheochromocytomas are usually recognized by the effects of overproduction of catecholamines, but there are clinical features that cannot be ascribed to catecholamine excess that may be due to vasoactive peptides. We, therefore, measured blood levels of vasoactive intestinal peptides (VIP), substance P, somatostatin (SS), and motifin in 50 instances in 37 patients with pheochromocytomas-21 malignant, 10 benign intra-adrenal, and 6 ectopic (5 paracardial and 1 perirenal). Hormone levels were considered raised if the level was more than 3 S.D. above the mean value found in 52 healthy subjects. Of the 37 patients, 20 (54%) had an abnormality in 1 or more gut hormone levels. The most common abnormality was a raised SS in 9/37 (24%). In addition to these, however, 3 (8%) others had raised VIP, 5 (13.5%) raised motilin, and 3 (8%) raised substance P. Patients with benign adrenal adenomas had raised levels of SS and substance P. Ectopic pheochromocytomas produced only SS in addition to catecholamines, but malignant pheochromocytomas could secrete all 4 peptides, and more than 1 in the same patient. We conclude that pheochromocytomas may secrete multiple vasoactive peptides, and they are more likely to do so if malignant. Somatostatin is the most commonly secreted peptide and is found with benign adrenal and ectopic (paracardiac) tumors. If the level of more than 1 peptide is elevated, the likelihood of malignancy is significantly increased.

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Factitious hyperinsulinemic hypoglycemia: confirmation of the diagnosis by a species-specific insulin radioimmunoassay

Walfish

Feig

Bauman³

1987

J Endocrinol Invest

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Surreptitious self-administration of insulin is an important cause of hypoglycemia. A 28-year-old female hospital ward clerk presented with hypoglycemia associated with an elevated plasma insulin level and a low plasma C-peptide concentration. Factitious illness was denied by the patient until it was definitively proven by using a species-specific insulin radioimmunoassay that the type of insulin circulating at the time of hypoglycemia was of animal rather than of human origin. The differential diagnosis of hypoglycemia associated with hyperinsulinemia and the current laboratory methods which may be employed to distinguish between factitious hypoglycemia and endogenous hyperinsulinism are discussed.

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Diagnosis and treatment of ‘insulinoma’

Cited by 5 publications

References 178 publications

Malignant islet‐cell tumors of the pancreas

Malignant islet‐cell tumors of the pancreas

Plasma gut hormone levels in 37 patients with pheochromocytomas

Factitious hyperinsulinemic hypoglycemia: confirmation of the diagnosis by a species-specific insulin radioimmunoassay

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