Extrapancreatic insulinoma

Garg, Robin; Memon, Saba Samad; Patil, Virendra; Bandgar, Tushar

doi:10.4103/wjnm.wjnm_41_19

Cited by 8 publications

(3 citation statements)

References 7 publications

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“…[6] Moreover, more than 90% of insulinomas originate from pancreatic β cells, with a probability of 1/3 in the head, body, and tail of the pancreas; and <2% of insulinomas occur outside the pancreas, most commonly on the duodenal wall. [7] NIPH can be divided into interstitial and epithelial tissue tumors according to their tissue of origin, with hepatocellular carcinoma most common, accounting for 23% of NIPH, and 4% to 27% of patients with hepatocellular carcinoma having hypoglycemia. [8] All 3 types of nondiabetic hypoglycemia meet the clinical characteristic criteria of the Whipple triad for hypoglycemic symptoms.…”

Section: Discussionmentioning

confidence: 99%

A review on nondiabetic hypoglycemia from various causes: Case series report

Gan,

Zhu,

Gao

et al. 2023

Medicine

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Rationale: Hypoglycemia is common in patients with glucose regulation disorders and related diabetic treatments but is rare in nondiabetic patients. Severe hypoglycemia can cause harm to patients’ cognition, consciousness, central nervous system, cardiovascular and cerebrovascular system, and even death. However, the most fundamental way to control hypoglycemia is to identify the cause and deal with the primary disease. This article introduces 3 cases of nondiabetic hypoglycemia with different causes, aiming to improve our understanding of nondiabetic hypoglycemia and improve the ability of early diagnosis and differential diagnosis. Patient concerns: Case 1 is a 19-year-old female with a history of recurrent coma, and magnetic resonance imaging and endoscopic ultrasound of the pancreas suggest insulinoma. Case 2 is a 74-year-old male with a history of viral hepatitis, and computerized tomography shows multiple nodules in the liver, which is diagnosed as liver cancer. Case 3 is a 39-year-old female with a history of taking methimazole, who tested positive for insulin antibodies, and was diagnosed with insulin autoimmune syndrome. Diagnosis: All 3 patients were diagnosed with nondiabetic hypoglycemia, but the causes varied, and included insulinoma, non-islet cell tumor-induced hypoglycemia, and insulin autoimmune syndrome. Interventions: Case 1 underwent pancreatic tail resection; case 2 refused anti-tumor treatment and received glucose injections for palliative treatment only; and case 3 stopped taking methimazole. Outcomes: After surgery, the blood sugar in case 1 returned to normal, and the blood sugar in case 2 was maintained at about 6.0 mmol/L. The symptoms of hypoglycemia gradually improved in case 3 after stopping the medication. Lessons: Non-diabetic hypoglycemia requires further examination to clarify the cause, and the correct differential diagnosis can provide timely and effective treatment, improving the patient’s prognosis.

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Section: Discussionmentioning

confidence: 99%

A review on nondiabetic hypoglycemia from various causes: Case series report

Gan,

Zhu,

Gao

et al. 2023

Medicine

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“…The annual incidence is estimated to be 1–4 cases per 1,000,000 persons, with 4–8% of these cases being associated with MEN1 [98, 99]. Extra-pancreatic insulinomas are rarely described [100, 101].…”

Section: Classification Based On Functionalitymentioning

confidence: 99%

Relation between WHO Classification and Location- and Functionality-Based Classifications of Neuroendocrine Neoplasms of the Digestive Tract

Helderman,

Suerink,

Kilinç

et al. 2023

Neuroendocrinology

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Practice of neuroendocrine neoplasms (NENs) of the digestive tract, which comprise of a highly diverse group of tumors with a rising incidence, faces multiple biological, diagnostic, and therapeutic issues. Part of these issues is due to misuse and misinterpretation of the classification and terminology of NENs of the digestive tract, which make it increasingly challenging to evaluate and compare the literature. For instance, grade 3 neuroendocrine tumors (NETs) are frequently referred to as neuroendocrine carcinomas (NECs) and vice versa, while NECs are, by definition, high grade and therefore constitute a separate entity from NETs. Moreover, the term NET is regularly misused to describe NENs in general, and NETs are frequently referred to as benign, while they should always be considered malignancies as they do have metastatic potential. To prevent misconceptions in future NEN-related research, we reviewed the most recent terminology used to classify NENs of the digestive tract and created an overview that combines the classification of these NENs according to the World Health Organization (WHO) with location- and functionality-based classifications. This overview may help clinicians and researchers in understanding the current literature and could serve as a guide in the clinic as well as for writing future studies on NENs of the digestive tract. In this way, we aim for the universal use of terminology, thereby providing an efficient foundation for future NEN-related research.

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“…El restante 10% son malignos (cuando presenta invasión local o metástasis a distancia), los cuales suelen ser mayores a 3 cm y asocian metástasis linfáticas (principalmente en retroperitoneo), hígado, peritoneo, entre otras.1-4 La manifestación clínica principal de los insulinomas es la hipoglicemia; en pacientes no diabéticos se debe realizar diagnóstico diferencial ante una hipoglicemia con un insulinoma, nesidioblastosis e hipoglicemia autoinmune. 5 A pesar de ser una condición que se describió por primera vez hace más de cien años, su diagnóstico continúa pasando por alto. La mayoría de los tumores causan síntomas cuando son pequeños, lo que permite un diagnóstico temprano y un tratamiento definitivo, sin embargo, más de la mitad de los pacientes son sintomáticos durante al menos 3.6 años antes de que se les dé el diagnóstico adecuado.6 Por lo anterior, es importante comprender los aspectos más importantes de estos tumores, de manera que se pueda realizar un diagnóstico oportuno y brindar el manejo adecuado.…”

Section: Introductionunclassified

Insulinoma: Una visión general.

Calderón

Marroquín

Chaves

et al. 2022

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Los insulinomas son los tumores neuroendocrinos más frecuentes, la mayoría son benignos y se localizan en el páncreas. Pueden ser esporádicos o estar asociadas a neoplasia endocrina múltiple tipo 1 (NEM1). Para realizar un diagnóstico oportuno es clave considerarlo en el diagnóstico diferencial de un paciente no diabético que se presenta con una hipoglicemia. La presentación clínica (tríada de Whipple), pruebas bioquímicas que confirmen una hipoglicemia hiperinsulinémica y la detección de una lesión tumoral en estudios de imagen son las partes fundamentales para el diagnóstico de esta neoplasia. El tratamiento curativo es quirúrgico, sin embargo, existen diferentes opciones terapéuticas tales como técnicas ablativas como la inyección de etanol o la ablación por radiofrecuencia, así como también es posible brindar manejo médico en pacientes no candidatos a cirugía.

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Extrapancreatic insulinoma

Cited by 8 publications

References 7 publications

A review on nondiabetic hypoglycemia from various causes: Case series report

A review on nondiabetic hypoglycemia from various causes: Case series report

Relation between WHO Classification and Location- and Functionality-Based Classifications of Neuroendocrine Neoplasms of the Digestive Tract

Insulinoma: Una visión general.

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