Long-standing insulinoma: two case reports and review of the literature

Abstract

BackgroundInsulinomas are rare pancreatic endocrine tumors. Most are benign and solitary. However, the nonspecific symptoms and small size of these tumors led to difficulties of diagnosis and localization.Case presentationWe present two Arab patients with pancreatic long-standing insulinoma. Both patients presented episodic hypoglycemic symptoms respectively during 10 and 2 years. Biochemical and morphological workup detected localized pancreatic insulinoma. Open procedure surgery was done for the two patients and insulinomas were successfully removed by enucleation.ConclusionInsulinoma remains a diagnostic challenge to practitioners. Diagnosis of suspected cases is easily confirmed by standard endocrine tests, especially the supervised fasting test. Accurate preoperative localization is essential for more effective and safest surgery.

Serum 25-hydroxyvitamin D concentration in Japanese Akita dogs: A survey

“…(2015) German Shepherd breed (mean value: 76.5 ng/mL) highlighted a 26% higher 25(OH)D concentration than Golden Retrievers (mean value: 60.6 ng/mL). In the investigated Akitas, the maximum value recorded for vitamin D was 144 ng/mL, which was lower compared to the one indicated by Sharp et al. (2015) for German Shepherds and Golden Retrievers (212.80 ng/mL and 249.20 ng/mL, respectively).…”

“…As reported by other Authors, breed significantly influenced serum vitamin D concentration. Indeed, as referred by Sharp et al. (2015) German Shepherd breed (mean value: 76.5 ng/mL) highlighted a 26% higher 25(OH)D concentration than Golden Retrievers (mean value: 60.6 ng/mL).…”

“…Despite the wealth of research on vitamin D and its relationship with chronic diseases, little has been studied in dogs ( Gerber et al., 2003 ; Gow et al., 2011 ; Rosa, Schoeman, Berry, Mellanby, & Dvir, 2013 ; Kraus et al., 2014 ; Selting et al., 2014 ; Sharp, Selting, & Ringold, 2015 ; Spoo et al., 2015 ; Titmarsh et al., 2015 ). At present, at our knowledge, no publications evaluating the vitamin D status in Japanese Akita breed are available.…”

Vague neuroglycopenic complaints camouflage diagnosis of adolescent insulinoma: a case report

“…As a result of their unregulated insulin secretion, the patients with insulinoma have impaired hepatic glycogenolysis, gluconeogenesis, and ketogenesis resulting in severe, recurrent hypoglycemia. In response to the hypoglycemia two categories of symptoms are observed: neurogenic and neuroglycopenic (Table 2 ) [ 7 ]. Neurogenic symptoms often can be quickly be identified as clinicians and even patients associate them with low blood sugar.…”

Insulinoma Camouflaged by Vague Neuroglycopenic Symptoms: A Case Report

“…Almost all insulinomas are located within the pancreas, even though aberrant cases have been described in the duodenum, ileum, lung, and cervix [1]. Most are sporadic; however, 10% of insulinomas are multiple and occur as part of multiple endocrine neoplasia syndrome type I (MEN-I) [2].…”