Insulinoma in Iran: a 20-year review

Abstract

BACKGROUNDThe time between onset of symptoms of insulinoma to diagnosis ranges from 10 days to more than 20 years. To help physicians make an earlier diagnosis, we defined the clinical, imaging and paraclinical characteristics of insulinoma in cases from seven referral hospitals in Iran over two decades.METHODSThe medical records of 68 cases with biochemical or histological evidences of insulinoma were reviewed.RESULTSMore males were affected (53%). The mean age at diagnosis was 39±15.3 years. The mean duration of symptoms was 39.9±59.3 months. Eighty-four percent of patients had been initially misdiagnosed as cereberovascular accident (CVA), epilepsy, conversion disorder, and others). Neuroadrenergic symptoms were observed in 89.6% and and neuroglycopenic symptoms in 97% of patients. Mean diameter of tumours was 2.9 cm (range, 1 cm to 8.5 cm). Of 52 pathologically confirmed cases of insulinoma, 43 tumours (87.8%) were single and 49 (94.2%) were benign. Fifty-five patients had undergone surgery, with a successful outcome in 44 (80%).CONCLUSIONThe high incidence of neuroglycopenic symptoms suggest the clinical impression of insulinoma when patients present with a suggestive clinical syndrome. The clinical impression is essential to decrease the frequent delay in the diagnosis of insulinoma.

Epidemiology of insulinoma in Tunisia

“…There was only one child in the series. Sex ratio and age at diagnosis were close to that described in other studies [1][2][3][4][5]. Mean diagnosis delay was 5 ± 6.9 years ranging from 4 months to 30 years.…”

A 60-year experience in the treatment of pancreatic insulinoma in the Military Medical Academy, Belgrade

“…A wide spectrum of clinical manifestations in patients with insulinoma as well as a large number of diseases that have similar symptoms and signs, may be the reasons for difficult recognition of disease and explain a long period between the onset of symptoms and the diagnosis. In the literature, the time from the onset of symptoms to insulinoma diagnosis varies widely, from 10 days to more than 20 years 19,20 , as in our patients. Since surgery is the only curative treatment of insulinomas, topographic assessment of insulinoma must be performed after the conformation of biological diagnosis of hypoglycemia related to inappropriate insulin secretion.…”

Management of Insulinoma

“…The percentage of 48-hour fasting tests with positive results was close to that reported (94%Y95.7%) in different studies. 3,6 Hyperinsulinemia was confirmed during a spontaneous hypoglycemia in 13 patients and during the fast test in 14 patients. It was superior to 3 KIU/mL in all patients, ranging from 8 to 400 KIU/mL.…”

“…Cryosurgery has become increasingly popular. 3 However, the safety and effectiveness of cryosurgery on pancreatic cancer is unclear. This study is intended to provide a systematic review.…”