Insulinoma—Accurate Preoperative Localization Is the Key to Management: An Initial Experience

Sharma, A.; Varshney, Peeyush; Kasliwal, Rajeev; Nagar, Anand; Venkatatelikicherla, Krishnavardhan; Sarin, Shiv Kumar; Choubey, R. P.; Kapoor, V. K.

doi:10.1007/s13193-022-01534-6

Cited by 4 publications

(4 citation statements)

References 67 publications

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“…A review of the relevant studies published from India was also compared and contrasted with the current study and the findings are summarized in Table 4 . [ 25 29 30 31 32 ] We found a male preponderance in our series which was like a prior report from India, contrasting with many Western series with female preponderance. Further, while the calculated sensitivity of CT scan was similar to our study, MRI in this series demonstrated better sensitivity than our study (85.7% vs 64.3%).…”

Section: Discussionsupporting

confidence: 82%

Diagnostic Modalities, Management Considerations, and Outcomes of Insulinoma: A Case Series from a Tertiary Care Centre

Shetty,

Das,

Jayant

et al. 2024

Indian Journal of Endocrinology and Metabolism

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Introduction: Insulinomas are rare, usually sporadic, and typically benign pancreatic neuroendocrine tumours. Pre-operative localization is challenging and evidence on comparative analysis of anatomic and scintigraphic modalities for pre-operative tumour localization is limited, even in contemporary series. Methods: The current study was designed to study the clinical features and management challenges of insulinomas managed at a tertiary care centre. Clinical features, diagnosis, imaging techniques, surgical procedures, and outcomes details were collated. Pre-operative imaging techniques (CT/MRI, nuclear scintigraphy) were compared with intraoperative and histopathological findings to assess their accuracy of localization. Results: Thirty-seven patients (15 females [42%]; median age 36 years [IQR 28–49]) were included in the study. In four patients (10.8%), the tumour occurred in the setting of multiple endocrine neoplasia type 1 (MEN 1) while the remaining were sporadic. The sensitivity of pre-operative localization was 61.5% (multiphasic CT), 66.6% (multiphasic MRI), 100% (68Ga Exendin-4 PET-CT), and 91.6% (EUS). Three patients with normal multiphasic CT had localization on 68Ga Exendin-4 PET-CT. The positive predictive value (PPV) of both Exendin-PET-CT and EUS was similar at 91.6% and 91.6%, respectively. All patients (except one with nesidioblastosis), who underwent enucleation or partial pancreatic resection, were cured. Conclusion: 68Ga Exendin-4 PET-CT based is a non-invasive imaging modality that has high sensitivity and PPV and can be used as a first-line imaging modality. The overall prognosis of these tumours is good with high cure rates attained following surgical resection.

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Section: Discussionsupporting

confidence: 82%

Diagnostic Modalities, Management Considerations, and Outcomes of Insulinoma: A Case Series from a Tertiary Care Centre

Shetty,

Das,

Jayant

et al. 2024

Indian Journal of Endocrinology and Metabolism

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“…EUS has a sensitivity of 94% alone and 100% when combined with CT. It also allows tissue diagnosis which can be very helpful, especially in small tumors [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Insulinoma Unmasked Post Sleeve Gastrectomy With Incidental Renal Cell Carcinoma: A Rare Case

Goel,

Kurlekar,

Chitharanjan

et al. 2024

Cureus

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Insulinoma is a functional pancreatic neuroendocrine tumor (pNET). Usually benign and solitary, these tumors present with recurrent episodes of hypoglycemia due to insulin hypersecretion. It's a rare cause of post bariatric surgery hypoglycemia and hence poses a diagnostic challenge.Here, we report the first case of a 53-year-old male with insulinoma unmasked post sleeve gastrectomy with incidental renal cell carcinoma (RCC). He presented with symptoms of Whipple's triad after two months of sleeve gastrectomy done for morbid obesity. On further inquiry, the patient gave a history of an asymptomatic peripancreatic neuroendocrine tumor (NET) for the past 11 years. With a suspicion of insulinoma, biochemical workup followed by non-invasive imaging like GA-68 DOTA and CT triphasic abdomen scan was done to guide the diagnosis of an insulinoma which also detected a second primary tumor in the right kidney, likely to be a malignant RCC. Following pancreatic mass excision with radical nephrectomy for right renal mass, histopathology (HPE) and immunohistochemistry (IHC) confirmed the diagnosis of an insulinoma and a right renal clear cell carcinoma. The patient was discharged with no further episodes of hypoglycemia. Hence, persistent hypoglycemia post bariatric surgery could be an indication of a hidden insulinoma and this possibility of synchronous tumors should be kept in mind when dealing with rare tumors like insulinoma.

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“…Therefore, in most of cases, different imaging modalities need to be sequentially performed before being able to identify the lesion. [6][7][8] In few patients, also invasive procedures (i.e., arterial stimulation venous sampling [ASVS]) are required in order to localize the insulin-secreting tumor, especially in the presence of multiple nodules. 9 Once the lesion has been identified, surgical resection represents the treatment of choice.…”

Section: Introductionmentioning

confidence: 99%

“…Second, preoperative tumor localization represents another major challenge, as insulinomas frequently measure <1 cm. Therefore, in most of cases, different imaging modalities need to be sequentially performed before being able to identify the lesion 6–8 . In few patients, also invasive procedures (i.e., arterial stimulation venous sampling [ASVS]) are required in order to localize the insulin‐secreting tumor, especially in the presence of multiple nodules 9 .…”

Section: Introductionmentioning

confidence: 99%

Diagnostic work‐up and surgical management of insulinoma: A retrospective analysis from a tertiary referral center

Andreasi,

Partelli,

Muffatti

et al. 2023

J Neuroendocrinology

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Insulinoma is a multifaceted disease that poses several challenges in terms of clinical presentation, diagnostic work‐up, and surgical management. The aim of this study was to describe diagnostic work‐up, surgical management, and postoperative outcomes of patients with insulinoma. All consecutive patients who underwent surgery for insulinoma at San Raffaele Hospital (Milan, Italy) between January 2008 and January 2022 were included. Overall, 98 patients were considered. The median delay between presenting symptoms and insulinoma diagnosis was 10 months (IQR, 4–21). Insulinoma diagnosis was made at our Institution in 45 patients, 20 of whom referred within 6 months from symptoms onset. In this subgroup, the median interval between symptoms presentation and insulinoma diagnosis was 4 months (IQR, 2–6), as compared to 14 months (IQR, 10–26) in patients (n = 25) who referred to our institution after 6 months from symptoms onset (p < .001). The insulinoma was localized preoperatively in all the cases. All patients underwent ≥1 high‐quality imaging: computed tomography (CT: n = 87, sensitivity 84%), magnetic resonance imaging (MRI: n = 55, sensitivity 85%) and endoscopic ultrasound (EUS: n = 79, sensitivity 100%). MRI identified the tumor in eight patients with negative CT. EUS localized the insulinoma in three patients with negative CT and negative MRI. Parenchyma‐sparing resections were performed in 41 patients. Contact with major vessels, lesion close to Wirsung duct and suspect of malignancy were the main reasons to perform a formal resection. An early referral to high‐volume centers is important for reducing diagnostic delay in patients with insulinoma. The diagnostic work‐up of insulinoma frequently requires several imaging modalities to be performed, with EUS being the most sensitive one. Parenchyma‐sparing surgery for insulinoma should be performed whenever technically and oncologically feasible.

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Insulinoma—Accurate Preoperative Localization Is the Key to Management: An Initial Experience

Cited by 4 publications

References 67 publications

Diagnostic Modalities, Management Considerations, and Outcomes of Insulinoma: A Case Series from a Tertiary Care Centre

Diagnostic Modalities, Management Considerations, and Outcomes of Insulinoma: A Case Series from a Tertiary Care Centre

Insulinoma Unmasked Post Sleeve Gastrectomy With Incidental Renal Cell Carcinoma: A Rare Case

Diagnostic work‐up and surgical management of insulinoma: A retrospective analysis from a tertiary referral center

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