Insulinoma and anaesthetic implications

Abstract

Insulinoma is a rare neuroendocrine tumour of the pancreas , which is usually small, solitary and benign. It may be part of the multiple endocrine neoplasia type 1 syndrome. It is diagnosed by clinical, biochemical and imaging modalities. Hypoglycaemic symptoms can be medically controlled by diazoxide or somatostatin analogues. Localisation of the tumour is a challenge to clinicians. Surgical resection is the curative treatment with a high success rate. Intraoperatively, ultrasound and surgical palpation help to confirm the site of tumour. Intraoperatively, maintenance of optimum glucose levels is of main concern because there may be severe hypoglycemia while handling the tumour, symptoms of which remain masked under general anaesthesia. Glucose infusion and frequent plasma glucose monitoring to maintain plasma glucose level more than 60 mg/dL is found to be helpful. We performed a systematic search in PubMed, Cochrane Library and also in Google. We used the following text words for our search: Insulinoma, neuro-endocrine tumors, multiple endocrine neoplasia, hypoglycemia, anaesthetic management of insulinoma, glucose management. In this article, we review the incidence and epidemiology of insulinoma, its clinical features, diagnosis, localisation and treatment, with special emphasis on anaesthetic management.

Glucose Management during Insulinoma Resection Using Real-Time Subcutaneous Continuous Glucose Monitoring

“…Ten percent of insulinomas occur as a part of multiple endocrine neoplasia type 1 (MEN-1), in which insulinoma occurs at a relatively young age [ 2 ]. It is challenging for anesthesiologists to control blood glucose (BG) during surgery for insulinoma resection [ 3 ]. A subcutaneous continuous glucose monitoring (SCGM) system, which allows real-time monitoring of interstitial glucose (IG), has been developed and is used in diabetic patients [ 4 ].…”

Perioperative implication of sudden manifestation of carcinoid tumor masquerading as insulinoma

“…[5] Restlessness in this patient during the immediate postoperative period was probably due to high central nervous system levels of this mediator.…”

Diagnostics and treatment of insulinoma

“…They are developed from pancreatic beta cells and the autonomous production of insulin is one of the most common causes of hypoglycemia by non-diabetic patients. Beside the production of insulin, production of even other hormones like gastrin, glucagon, somatostatin, serotonin, adrenocorticotropic and human choriogonadotropic hormone can be present [2]. Estimated incidence is 1 -4 people per million [3].…”

“…Slightly higher incidence by women than by men is observed (60 : 40 %). [2] Most of the insulinomas are located in the pancreas with equally distribution over its parts. Extrapancreatic occurrence of the primary lesion is extremely rare (incidence < 1 %) and the most frequent locations are duodenum, ileum, lungs, ovary and cervix [1,6].…”