Sporadic Insulinoma as a Rare Cause of Recurrent Hypoglycemia in Children

Saneifard, Hedyeh; Tabari, Ahmad Khaleghnejad; Aghdam, Maryam Kazemi; Khorshidi, Mohadese Musavi; Sheikhy, Ali

doi:10.1155/2017/4756793

Cited by 5 publications

(6 citation statements)

References 9 publications

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“…Elevated insulin levels support the diagnosis of insulinoma. GH examination can rule out causes of hypoglycemia due to GH deficiency [8]. This patient had an elevated insulin level of 92.1 u IU/ml (normal 3.2-28.5 μIU/ml).…”

Section: Discussionmentioning

confidence: 87%

Recurrent Hypoglycemia in Baby with Insulinoma: A Case Report

Prabandari

Wande

Mahartini

2022

Open Access Maced J Med Sci

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BACKGROUND: Insulinoma is a functional neuroendocrine tumor in the pancreas that can cause hypoglycemia due to endogenic hyperinsulinism. Insulinoma is a rare case with an incidence of 1–4 cases per million people each year. Insulinoma can occur at various ages and mostly occurs in adults with a predominance in women. CASE REPORT: A baby boy aged 1 month 23 days was referred from Prof. Dr. W. Z. Johannes Hospital with the chief complaint was seizures. The results of the examination of blood glucose levels at Sanglah Hospital were 28 mg/dl. There were some episodes of normal blood glucose level in the patient after having some doses of glucose infusion therapy. However, it was only for a while, the blood glucose level came back low and induced the symptoms of the seizure (neuroglycopenia). The seizures stopped after having anticonvulsant therapy and blood glucose levels within normal limits. These symptoms were consistent with the Whipple triad in insulinoma. The patient has an elevated insulin level (92 IU/ml). Computed tomography scan of the abdomen with contrast showed a mass in the caudal part of the pancreas. The patient underwent a partial pancreatectomy. Histomorphology features showed pancreatic neuroendocrine tumors without metastases. Immunohistochemical results of Ki-67 showed well-differentiated neuroendocrine tumors grade 2. CONCLUSION: Based on clinical, physical examination, laboratory, and radiology findings, the patient was diagnosed with recurrent hypoglycemia due to insulinoma and improved with partial pancreatectomy.

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Section: Discussionmentioning

confidence: 87%

Recurrent Hypoglycemia in Baby with Insulinoma: A Case Report

Prabandari

Wande

Mahartini

2022

Open Access Maced J Med Sci

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“…Diagnosis of insulinoma is often delayed because signs and symptoms are commonly seen in a variety of other diseases [5]. Noninvasive localization studies 18F-Dopa PET-CT scan can be used to diagnose CHI.…”

Section: Discussionmentioning

confidence: 99%

“…Diagnosis of insulinoma is often delayed because signs and symptoms that occur following hypersecretion of insulin by this tumor and consequent hypoglycemia and neuroglycopenia are commonly seen in a variety of other diseases. Prompt and early diagnosis of insulinoma is very important because it can cause recurrent hypoglycemia which can consequently cause irreversible neurologic damage [4], [5]. Management of insulinoma aims to maintain normal blood glucose levels.…”

Section: Introductionmentioning

confidence: 99%

Case of Insulinoma in a 2-Months-Old Infant

Pangestika

Arimbawa

Yuda

et al. 2022

Open Access Maced J Med Sci

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INTRODUCTION: Insulinoma is congenital hyperinsulinism of infancy (CHI). It is a type of functional neuroendocrine tumor (NET) in the pancreas that manifests with persistent hypoglycemia caused by inappropriately high secretion of insulin (hyperinsulinemia). Comprehensive and multidisciplinary management is required for a better outcome. CASE PRESENTATION: A 2-months-old girl came to the Emergency unit Sanglah Hospital, with a chief complaint of seizure. The patient had a low blood glucose level, high fasting insulin, high LDH, computed tomography of the abdomen result showed isodense heterogeneous lesions border in the cauda pancreas with size 1.32 × 1.24 × 1.35 cm. The anatomy-pathological result showed pancreatic neuroendocrine tumor WHO Grade II, functional, consistent, and clinically to insulinoma on the tail of the pancreas. The patient was treated with hydrocortisone, nifedipine, and octreotide. The patient underwent laparotomy partial pancreatectomy. In post-surgery condition, she had good drink tolerance, no episode of recurrent seizure, and blood glucose was controlled. CONCLUSION: Insulinoma is a rare disease. The diagnosis was challenging. This case report presents the diagnostic work-up and management of a patient with a persistent hypoglycemia condition that was diagnosed as insulinoma.

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“…When using drugs to induce cell death, it must be taken into consideration about the possibility that the sudden death of a large amount of insulinoma cells in a patient might release too much insulin and cause fatal hypoglycemia [40][41][42][43][44][45][46]. However, this may not be a problem for R115777 therapy because it induces tumor cell apoptosis and the apoptotic cells or apoptotic bodies are engulfed by macrophages through phagocytosis and the insulin inside the dead cells/bodies will most possibly be degraded by the lysosomal enzymes of the macrophages [47][48][49][50].…”

Section: Discussionmentioning

confidence: 99%

A farnesyl transferase inhibitor induces apoptosis of insulinoma pancreatic β cells of mouse

Gao¹,

Fu²,

Liu³

et al. 2018

biomedicalresearch

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This study is to investigate the effect of a Farnesyl Transferase Inhibitor (FTI) R115777 on apoptosis of mouse insulinoma pancreatic β cells. MTT assay was used to investigate the proliferative inhibition of in vitro cultured mouse insulinoma pancreatic β cell lines by a FTI R115777. The morphological changes of the cells were observed using a fluorescence microscope by staining with Hoechst 33258 and propidium iodide after the treatment with FTI R115777. The apoptosis rate of R115777-treated beta-TC-6 cells was detected by flow cytometry. The expressions of caspase-3 and caspase-9 of the R115777-treated beta-TC-6 cells were assayed by spectrophotometry. In addition, the sub-cellular distribution of cytochrome c and the expressions of Bax and Bcl-2 proteins were detected by Western blot. After the treatment with FTI R115777, the proliferation of the mouse insulinoma pancreatic β cell lines was significantly inhibited. Significant apoptosis was observed in the treated beta-TC-6 cells. The effect of R115777 on the apoptosis of beta-TC-6 cells showed time-and dose-dependent manners. The expressions of caspase-3, caspase-9 and Bax in the R115777-treated beta-TC-6 cells increased, while the expression of Bcl-2 decreased. The sub-cellular distribution of cytochrome-c changed, with reduced cytochrome-c in mitochondria and increased cytochrome-c in cytoplasm. FTI R115777 can inhibit the proliferation of mouse insulinoma pancreatic β cell lines, and might induce cell apoptosis through the mitochondrionmediated pathway. R115777 could be further studied as a potential antitumor drug.

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Sporadic Insulinoma as a Rare Cause of Recurrent Hypoglycemia in Children

Cited by 5 publications

References 9 publications

Recurrent Hypoglycemia in Baby with Insulinoma: A Case Report

Recurrent Hypoglycemia in Baby with Insulinoma: A Case Report

Case of Insulinoma in a 2-Months-Old Infant

A farnesyl transferase inhibitor induces apoptosis of insulinoma pancreatic β cells of mouse

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