Localization of Insulinomas

Boukhman, Milana P.; Karam, John M.; Shaver, John K.; Siperstein, Allan; deLorimier, Alfred A.; Clark, Orlo H.

doi:10.1001/archsurg.134.8.818

Cited by 99 publications

(69 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…11 Recommendations regarding investigation of patients with insulinoma before surgical resection, surgical technique and prognostic factors are not clearly defined. [12][13][14] A delay in diagnosis is a common feature of patients with insulinomas. The median duration of symptoms before diagnoses in 224 patients treated at the Mayo Clinic over 60 years was 18 months, 1 which is equivalent to our series.…”

Section: Discussionmentioning

confidence: 99%

Improved Contemporary Surgical Management of Insulinomas

Nikfarjam¹,

Warshaw²,

Axelrod³

et al. 2008

Annals of Surgery

191

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Improved Contemporary Surgical Management of Insulinomas

Nikfarjam¹,

Warshaw²,

Axelrod³

et al. 2008

Annals of Surgery

191

View full text Add to dashboard Cite

show abstract

“…1 The majority of insulinomas are small, measuring less than 2 cm. 4,5 Despite its rare occurrence, insulinoma is the most common functional neuroendocrine tumor. 6 Although the large majority of insulinomas are sporadic, up to 10% may be associated with hereditary multiple endocrine neoplasia type I (MEN-1).…”

Section: Demographicsmentioning

confidence: 99%

“…3,15 This success has been difficult to match after the 1990s as only 29%-50% of insulinomas were localized using arteriography. 5,15 Additional problems with cost, and technical difficulties have also impacted its utility as a first-line study for insulinoma. Moreover, the success, availability, and increased use of the aforementioned noninvasive diagnostic techniques have also contributed to the decreased application of invasive angiography.…”

Section: Preoperative Localizationmentioning

confidence: 99%

“…4,9,15,18 Localization with palpation for tumors less than 1 cm in diameter has a sensitivity of 69%, which increases to 79% for tumors ranging from 1.2 to 3 cm. 5 Intraoperative blood glucose monitoring has also been used to confirm the removal of all hyperfunctioning islet tissue, based on an increase of 30 mg/dL in blood sugar level in samples taken before and after tumor resection (Figure 3). 15 Despite a reported sensitivity of 87%, intraoperative blood glucose monitoring has been used very infrequently because hypoglycemia during the …”

Section: Open Approachmentioning

confidence: 99%

See 1 more Smart Citation

Diagnosis and management of insulinoma: current best practice and ongoing developments

Taye¹,

Libutti²

2015

RRED

View full text Add to dashboard Cite

Insulinoma is a predominantly benign and rare neuroendocrine tumor. Patients with insulinoma typically present with neurologic symptoms from hypoglycemia, such as confusion, dizziness, and behavioral changes, as well as symptoms from a surge in catecholamine levels, such as palpitations, diaphoresis, and tachycardia. Symptomatic patients usually have glucose levels below 55 mg/dL and are relieved of their symptoms when carbohydrate is administered. The 48-hour test, performed by measuring blood glucose levels of insulin, C peptide, and proinsulin collected every 4-6 hours in fasting patients, accurately confirms the diagnosis of insulinoma in the majority of the patients. Once the diagnosis is confirmed, the next step in management involves identifying the location of the tumor and successfully removing it surgically. In the last two decades, clinicians have moved away from invasive angiography for preoperative localization. A multiphase computed tomography (CT) can be used to localize the lesion and evaluate for metastasis. If CT does not detect the lesion, selective arterial calcium stimulation test is recommended to identify the region of the lesion in the pancreas. Some argue that all preoperative localization techniques are superfluous. The combination of intraoperative ultrasound and operative palpation has led to a nearly 100% success rate. Recently, in select cases, laparoscopic enucleations and resections of insulinomas have been performed with shorter length of stay and faster recovery time. Despite advances in imaging, a little over 10% of insulinoma patients undergo reexploration for missing lesions. Patients who are not candidates for tumor resections or awaiting surgery have had symptomatic relief from diazoxide and somatostatin analogs among various medical therapies. In patients with metastatic insulinoma, progressionfree survival and overall survival are reported from newly approved chemotherapeutic agents. Liver-directed therapies, such as ablation and selective radiation, and cytoreductive surgery have also been performed for symptom control and prolonging survival.

show abstract

“…The main clinical manifestation is hypoglycemia secondary to inappropriate insulin hypersecretion and, in a minority (< 10%) of cases, tumoral progression due to malignant transformation. Multiple insulinomas are observed in about 10% of cases, usually in patients presenting multiple endocrine neoplasia type 1 (MEN1) (1,2). Although octreotide, a somatostatin analogue, has been widely used in the symptomatic treatment of patients with pancreatic NETs (3), surgery remains the only curative treatment in localized insulinomas.…”

Section: Introductionmentioning

confidence: 99%

Giant Malignant Insulinoma Which Developed from a Non-Functioning Pancreatic Tumor Over a Long Period of Time

et al. 2010

View full text Add to dashboard Cite

Insulinomas are the most common hormone-producing pancreatic neuroendocrine tumors (NETs), which are usually benign, solitary and small. We describe herein a patient with a giant insulinoma (>10 cm in diameter) with concomitant thyroid tumor as detected by Somatostatin receptor scintigraphy (SRS). A 50-yearold man presented hypoglycemic symptoms 20 years after the first detection of a pancreatic tumor, which was ameliorated by administration of a somatostatin analogue, octreotide. SRS showed abnormal uptake by the insulinoma as well as by the thyroid tumor. RT-PCR and immunohistochemical study revealed abundant expression of somatostatin receptor (SSTR)-1, -2, and -5 in his insulinoma and SSTR-1 and -2 in his thyroid follicular neoplasm. This is a rare case of a slow-growing pancreatic well-differentiated neuroendocrine carcinoma over a long period of time to become a symptomatic giant insulinoma. Furthermore, SRS proves to be a useful tool for localization of insulinoma as well as concomitant thyroid neoplasm with predominant expression of SSTRs.

show abstract

Localization of Insulinomas

Cited by 99 publications

References 10 publications

Improved Contemporary Surgical Management of Insulinomas

Improved Contemporary Surgical Management of Insulinomas

Diagnosis and management of insulinoma: current best practice and ongoing developments

Giant Malignant Insulinoma Which Developed from a Non-Functioning Pancreatic Tumor Over a Long Period of Time

Contact Info

Product

Resources

About