Insulinoma in pregnancy (a case presentation and systematic review of the literature)

Dobrindt, Eva Maria; Mogl, Martina T.; Goretzki, P. E.; Pratschke, Johann; Dukaczewska, Agata

doi:10.1177/2036361320986647

Cited by 7 publications

(12 citation statements)

References 53 publications

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“…Insulinomas are a rare pathology, and very few cases of insulinoma in pregnancy have been reported in the literature [4][5][6][7][8][10][11][12]. These tumors are characterized by symptomatic hypoglycemia, based on the results of a fasting glucose test at 48 to 72 hours [7,13], with neuroglycopenic symptoms.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Insulinoma Management in a Pregnant Woman: A Case Report

Diaz-Sangines¹,

Gonzalez-Cofrades²,

Vazquez-Camacho³

et al. 2023

Cureus

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An insulinoma is a rare tumor that originates in the β cells of the pancreas with an incidence of four cases per million people per year. To our knowledge, 40 cases of insulinoma in pregnancy have been reported. Insulinoma in pregnancy is usually diagnosed in the first trimester. Surgical treatment is advised during the second trimester with complications arising in up to 10% of cases. We present the case of a 34-year-old pregnant woman diagnosed with insulinoma during the first trimester. The patient underwent a laparoscopic resection of the tumor at 15.5 weeks of gestation. Insulinoma was resected and postoperative complications were managed, including acute pancreatitis and peripancreatic and splenorenal fluid collection, which were treated using multidisciplinary management and resolved at the end of the pregnancy at 40.1 weeks of gestation.

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Section: Discussionmentioning

confidence: 99%

“…Currently, only 40 cases of insulinoma in pregnant women have been reported worldwide, with only one case reported in Mexico [5]. Most cases are recognized or become symptomatic during the first trimester [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Insulinoma Management in a Pregnant Woman: A Case Report

Diaz-Sangines¹,

Gonzalez-Cofrades²,

Vazquez-Camacho³

et al. 2023

Cureus

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“…Особую категорию пациентов составляют беременные женщины. У данного контингента инсулинома наиболее часто диагностируется в первом триместре беременности, при этом оперативное вмешательство рекомендуется выполнять во втором триместре либо после родов [ 13 ].…”

Section: хирургическое лечениеunclassified

“…В качестве препаратов второй линии, а также при злокачественных инсулиномах используются аналоги соматостатина — в первую очередь октреотид. При злокачественных инсулиномах возможно также применение эверолимуса [ 13 ].…”

Section: медикаментозное лечениеunclassified

Current views on the treatment of insulinoma

Chernykh,

Malyugin,

Khachaturov

et al. 2024

Probl Endokrinol (Mosk)

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Relevance: Insulinoma is the most common hormonally active neuroendocrine tumor (NET) of the pancreas. In recent years, there has been a trend towards an increase in the incidence of NET especially insulinoma.Aim: Summarizing and analyzing current data on various approaches to the treatment of insulinoma. Our review includes a comprehensive assessment of the advantages and disadvantages of currently available insulinoma treatment methods in comparison with past experience, as well as a review of promising methods that are not currently widely used.Materials and methods: Analysis of literature from such databases as scientific electronic library elibrary.ru, Pubmed, Google Scholar, MedLine, Scopus and Web of Science.Results: The most common treatment for insulinoma is surgery. For patients with high operative risk, alternative methods such as alcohol ablation, radiofrequency ablation, and tumor embolization may be used. Medications include the use of somatostatin analogues, diazoxide. The literature describes the potential benefit of the use of beta-blockers, phenytoin, glucagon, however, in clinical trials, these drugs have not demonstrated a significant effect. For the treatment of malignant and metastatically advanced insulinoma, targeted therapy (primarily Everolimus), chemotherapy, as well as embolization (including chemoembolization, radioembolization), radiofrequency ablation (RFA), microwave ablation and cryoablation, ultrasound ablation (HIFU), laser ablation, brachytherapy, irreversible electroporation are used.Conclusion: The study of new drugs is an important task for scientists, among medications the most promising are new generations of somatostatin analogues, targeted drugs and chemotherapy drugs. The rare frequency of insulinoma makes it difficult to conduct randomized controlled trials and prospective studies. That is why physicians and scientists need to maintain close contacts with each other and take into account the experience of treating each patient with such disease, which will help develop effective treatment algorithms in the future.

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“…Pregnancy is considered a physiological state of insulin resistance, hence an insulinoma first presenting as hypoglycemia in pregnancy is rare. While insulinomas presenting in pregnancy are described in the literature [ 1 , 2 ], the majority of these cases present in the first trimester (before peak insulin resistance) or post partum. We report the case of a young woman who presented with symptomatic hypoglycemia in her second trimester of pregnancy, which was subsequently confirmed to be due to an insulinoma.…”

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confidence: 99%

Insulinoma Presenting With Postprandial Hypoglycemia in a Pregnant Woman With MEN-1

et al. 2022

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Insulinomas are rare insulin-secreting tumors of pancreatic origin that cause hypoglycemia and can be associated with multiple endocrine neoplasia type 1 (MEN1). Whilst rare, they are the most common cause of hypoglycemia related to endogenous hyperinsulinism. A 28 year old woman with known MEN1 presented with postprandial hypoglycemia in second trimester of pregnancy. Prior to her presentation she was known to have several pancreatic neuroendocrine tumors which had been stable on serial imaging, but no history of hypoglycemia. She was managed with dietary intervention during pregnancy and gave birth to a healthy baby at 37 weeks gestation. After pregnancy, hypoglycemia initially resolved, but then recurred at 8 months postpartum. Magnetic resonance imaging showed several pancreatic neoplasms with the largest lesion measuring 29 mm in the pancreatic tail, unchanged from previous imaging. After localization with a selective arterial calcium stimulation test, she underwent successful distal pancreatectomy with resolution of symptoms. This case is unusual in that her initial presentation was during pregnancy, she had predominantly postprandial rather than fasting hypoglycemia and her symptoms remitted for several months after delivery. Key learning points are to have a low index of suspicion for an insulinoma when there is a history of MEN1 and the need for a pragmatic approach to diagnosis and treatment during pregnancy.

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Insulinoma in pregnancy (a case presentation and systematic review of the literature)

Cited by 7 publications

References 53 publications

Insulinoma Management in a Pregnant Woman: A Case Report

Insulinoma Management in a Pregnant Woman: A Case Report

Current views on the treatment of insulinoma

Insulinoma Presenting With Postprandial Hypoglycemia in a Pregnant Woman With MEN-1

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