Type 2 diabetes mellitus in a patient with malignant insulinoma manifesting following surgery

Ademoglu, Esra Nur; Ünlütürk, Uğur; Ağbaht, Kemal; Karabork, Ayca; Çorapçıoğlu, Demet

doi:10.1111/j.1464-5491.2012.03603.x

Cited by 13 publications

(9 citation statements)

References 22 publications

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“…The insulin resistance is masked by the functioning tumor, but is overtly manifest after its excision. 15 Our patient had a BMI of 40 pre-operatively, and so could potentially fit this hypothesis.…”

Section: Discussionmentioning

confidence: 56%

Elevated Pancreatic Polypeptide Levels in Pancreatic Neuroendocrine Tumors and Diabetes Mellitus

Maxwell¹,

O’Dorisio²,

Bellizzi³

et al. 2014

Pancreas

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Pancreatic neuroendocrine tumors (PNETs) that secrete primarily pancreatic polypeptide (PP) are rare and usually nonfunctional. There are approximately two-dozen reports of PP-secreting PNETs, and three that have been associated with diabetes mellitus (DM). None suggest a mechanism for the association between PP-secreting PNETs and DM. We describe five patients with PP-producing tumors who were diagnosed with DM at the same time as their PNETs, review the literature on PP, and consider its role in the pathophysiology of diabetes mellitus. The cases discussed were extracted from our surgical neuroendocrine tumor database. We examined all patients with PP-predominant PNETs—both with DM (n=5) and without (n=8). The five patients with DM at the time of PNET diagnosis demonstrated improvement or resolution of their DM post-operatively. In the patients with PP-secreting PNETs but no diagnosis of DM pre-operatively, one became hypoglycemic post-operatively, and two others developed post-operative DM. The five cases discussed in detail raise the question of whether the hypersecretion of PP in PNETs might be an important event leading to the development of diabetes mellitus. Although the literature does not provide a mechanism for this association, it may be related to the role of PP in hepatic glucose regulation.

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Section: Discussionmentioning

confidence: 56%

Elevated Pancreatic Polypeptide Levels in Pancreatic Neuroendocrine Tumors and Diabetes Mellitus

Maxwell¹,

O’Dorisio²,

Bellizzi³

et al. 2014

Pancreas

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“…The absence of both proven autoimmunity and inflammatory infiltration together with adequate glycemic control on oral hypoglycemic agents suggests type 2 diabetes mellitus. A prolonged supervised fast is a gold standard test to evoke hypoglycemic episodes and is also useful in patients with diabetes mellitus [ 10 ]. This was not performed in our patient, as he manifested with unprovoked hypoglycemia.…”

Section: Discussionmentioning

confidence: 99%

“…However, we expect hypoglycemia to be more frequent and severe in the presence of malignant insulinoma depending on the size of the tumor and presence of metastases. A case report demonstrated paradoxical weight gain in a subject who had both type 2 diabetes mellitus and malignant insulinoma, and the explanation for the weight gain lies in recurrent eating to avoid hypoglycemia [ 10 ]. Distinction between malignant and benign tumors can only be made by the presence of metastasis, as there are no specific morphologic, biochemical, or genetic features distinguishing them.…”

Section: Discussionmentioning

confidence: 99%

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Challenge of coexisting type 2 diabetes mellitus and insulinoma: a case report

2021

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Background Insulinomas are rare clinical entities, but concurrent diabetes mellitus is even more uncommon, and the combination is easily missed. Recurrent hypoglycemia could be misconstrued as improved glycemic control. We present an unusual patient with type 2 diabetes and neuroglycopenia, with apparent improved glycemic control due to an insulinoma. Case presentation A 54-year-old mixed ancestry man with a positive family history of type 2 diabetes mellitus was diagnosed with type 2 diabetes mellitus and hypertension 8 years prior to admission. He presented with episodes of abnormal behavior and hypoglycemia. Inappropriately high insulin and C-peptide concentrations were identified at the time of hypoglycemia. Despite poor adherence to his diabetic treatment, he had no target organ damage relating to diabetes, and his hemoglobin A1c (HbA1c) was 5.3%. A diagnosis of insulinoma was made, and he was started on diazoxide, with endoscopic ultrasound revealing a possible lesion in the pancreatic tail measuring 12 mm × 12 mm. A fine-needle aspiration biopsy could not be performed due to overlying splenic arteries and the risk of vascular perforation. An intraoperative ultrasound confirmed a 15 mm × 10 mm tumor in the pancreatic tail, necessitating a partial pancreatectomy and splenectomy, which were curative. A well-differentiated intermediate grade 2 pancreatic neuroendocrine tumor producing insulin was confirmed on histopathology. Conclusions Recurrent, progressive hypoglycemia and improved glycemic control in a diabetic, without an alternative explanation, may suggest an insulinoma. Insulinomas that exist with type 1 diabetes mellitus, particularly malignant insulinomas, must have escaped autoimmune attack through lack of autoantigen expression. Computed tomography on its own may be insufficiently sensitive for diagnosis of insulinomas, whereas endoscopic and intraoperative ultrasonography may improve the identification of the culprit lesion.

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“…In this report, we described a malignant insulinoma with multiple liver metastases in a 66-year-old man with longstanding type 2 DM. Although benign insulinoma occurs rarely in patients with pre-existing DM [15][16][17], malignant insulinoma in this population seems to be even rarer, and only sparse cases are described in the literature, in both type 2 [18][19][20][21][22][23] and type 1 DM [12,24,25]. However, despite the rare occurrence of insulinoma in diabetic population, clinicians should be aware of this possible differential diagnosis when managing diabetic patients with recurrent episodes of symptomatic hypoglycemia despite tapering and withdrawal of glucose-lowering drugs.…”

Section: Discussionmentioning

confidence: 99%

Malignant Insulinoma with Multiple Liver Metastases and Hypercalcitoninemia in a Patient with Type 2 Diabetes Mellitus Presenting as Recurrent Episodes of Diaphoresis due to Severe Hypoglycemia

Ciacciarelli

Caruso

Rengo

et al. 2020

Case Reports in Endocrinology

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Insulinoma is an insulin-producing pancreatic neuroendocrine tumor that can be malignant in about 10% of cases. Locoregional invasion, lymph node metastases, or remote metastases are the main criteria of malignant insulinoma. Its incidence in patients with pre-existing diabetes mellitus (DM) is exceptionally rare. In this report, we describe a 66-year-old man with long-standing type 2 DM who presented with recurrent episodes of diaphoresis due to severe hypoglycemia despite the withdrawal of insulin therapy, hypercalcitoninemia, and biochemical and radiological findings suggestive of metastatic malignant insulinoma. Unfortunately, after few days of diazoxide treatment, edema, hypotension, oliguria, and water retention were observed, patient's clinical status deteriorated rapidly, and he died in our department from acute renal failure.

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Type 2 diabetes mellitus in a patient with malignant insulinoma manifesting following surgery

Abstract: Although this is a rare condition, clinicians should bear in mind that insulinomas may exist together with diabetes mellitus, and it is important to have this suspicion when considering the perioperative approach and for the prevention of morbidities.

Cited by 13 publications

References 22 publications

Elevated Pancreatic Polypeptide Levels in Pancreatic Neuroendocrine Tumors and Diabetes Mellitus

Elevated Pancreatic Polypeptide Levels in Pancreatic Neuroendocrine Tumors and Diabetes Mellitus

Challenge of coexisting type 2 diabetes mellitus and insulinoma: a case report

Malignant Insulinoma with Multiple Liver Metastases and Hypercalcitoninemia in a Patient with Type 2 Diabetes Mellitus Presenting as Recurrent Episodes of Diaphoresis due to Severe Hypoglycemia

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