Insulinoma in a patient with type 2 diabetes

Munir, Alia; Toh, S.L.; Arutchelvam, V

doi:10.1002/pdi.1599

Cited by 2 publications

(1 citation statement)

References 15 publications

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“…4 However, there are case reports of insulinomas developing in patients with type-2 diabetes. 5,6 Radiologically, the pancreatic tail lesion could have been an insulinoma. 90% of insulinomas are less than 2 cm in diameter.…”

Section: Discussionmentioning

confidence: 99%

Lesson of the month 2: An unusual presentation of hyperinsulinaemic hypoglycaemia with possible underlying diagnosis of glucose-sensitive insulinoma or islet cell hyperplasia

Maguire

2015

Clinical Medicine

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Lesson of the month 2: An unusual presentation of hyperinsulinaemic hypoglycaemia with possible underlying diagnosis of glucose-sensitive insulinoma or islet cell hyperplasia Postprandial hypoglycaemia can occur in islet cell hyperplasia and in reactive hypoglycaemia. Less commonly, it can occur with insulinoma. A case is described where the differential diagnosis was glucose-sensitive insulinoma or islet cell hyperplasia. Typical provocation was prolonged exertion or fasting followed by ingestion of sugary snacks resulting in hypoglycaemic seizures and collapse. Biochemistry and computerised tomography imaging were consistent with an insulinoma in the pancreatic tail, but this was not confirmed on endoscopic ultrasound. Selective intra-arterial calcium stimulation with hepatic venous sampling results suggested a diagnosis of islet cell hyperplasia. Ten years later, repeat imaging was consistent with a neuroendocrine tumour. Surgical resection has resulted in remission of symptoms. The patient will be monitored long term to ensure no recurrence.

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Section: Discussionmentioning

confidence: 99%

Lesson of the month 2: An unusual presentation of hyperinsulinaemic hypoglycaemia with possible underlying diagnosis of glucose-sensitive insulinoma or islet cell hyperplasia

Maguire

2015

Clinical Medicine

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Insulinoma in Patients with Diabetes- A Systematic Review of Previously Reported Cases

Chatterjee,

Bhattacharjee,

Ghosh

et al. 2024

Indian Journal of Endocrinology and Metabolism

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Introduction: Paradoxical co-existence of insulinoma and diabetes is extremely rare. Although a few case reports addressed this association, a comprehensive study elucidating this relationship has been lacking. We performed a systematic review of published cases of insulinoma in diabetes. Methods: We conducted a literature search using PubMed and Google Scholar, employing various combinations of the following terms: ‘insulinoma’, ‘diabetes’, ‘nesidioblastosis’, ‘endogenous hyperinsulinism’, ‘hypoglycaemia’, and ‘hyperglycaemia’ (from January 1900 to January 30, 2024). Exclusion criteria included non-English publications, duplicate articles, reports lacking sufficient data, cases of endogenous hyperinsulinemic hypoglycaemia other than insulinoma, and inaccessible articles. Statistical analysis was performed using appropriate methods. Results: Sixty patients were considered for the final analysis. Mean age was 61 ± 15 years (range: 17–96 years) with a slight female preponderance; 88.3% had type-2 diabetes with a median duration of 8 years. The median delay in diagnosis of insulinoma was 6 months. Median blood glucose varied from 30.5 mg/dL to 235 mg/dL, with a mean HbA1c of 5.6 ± 1.3% (range: 2.9%–8.2%). Critical sampling data were available in 75% of cases. The median size of the insulinoma was 2 cm. Furthermore, 5.2% of insulinomas were extra-pancreatic. Among pancreatic insulinomas, 14.5% were multi-focal. One-third of cases were malignant. Surgical resection was done in 70.9% of cases, while 40% received drug therapy and 12.7% received both, with 20.7% overall mortality. Malignant insulinoma (P = 0.007), micro-angiopathic (P = 0.018) and macro-angiopathic complications (P = 0.039), and other co-morbidities (P = 0.009) were associated with unfavourable prognosis, while being overweight and obese (P = 0.020) at presentation was associated with favourable prognosis. Conclusion: This first systematic review provides insights into the uniqueness of insulinoma in diabetes.

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Insulinoma in a patient with type 2 diabetes

Cited by 2 publications

References 15 publications

Lesson of the month 2: An unusual presentation of hyperinsulinaemic hypoglycaemia with possible underlying diagnosis of glucose-sensitive insulinoma or islet cell hyperplasia

Lesson of the month 2: An unusual presentation of hyperinsulinaemic hypoglycaemia with possible underlying diagnosis of glucose-sensitive insulinoma or islet cell hyperplasia

Insulinoma in Patients with Diabetes- A Systematic Review of Previously Reported Cases

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