Evaluation of Insulinoma Cases Presented with Hyperinsulinemic Hypoglycemia: A single-centre Experience

Year 2022, Volume: 4 - Supplement 1, 23 - 28, 01.04.2022

Ensar Aydemir , Coşkun Ateş , Filiz Mercan Sarıdaş , Erhan Hocaoğlu , Soner Cander , Özen Öz Gül , Erdinç Ertürk , Canan Ersoy

https://doi.org/10.46310/tjim.1073351

Cited By: 1

Abstract

Introduction
Insulinomas constituting the most common cause of endogenous hyperinsulinism-related hypoglycemia are neuroendocrine tumors originating from pancreatic beta cells. They are generally benign and solitary lesions. Although most cases are sporadic, multiple endocrine neoplasia (MEN) 1-related patients are also present.
Material and Method
Thirteen patients followed up in Bursa Uludağ University Medical Faculty Endocrinology and Metabolic diseases clinic between the years 2012 and 2021 were retrospectively evaluated. Demographical, clinical, biochemical, radiological and histopathological data of the patients were assessed.
Results
Eight of the patients were females, and five were males with an average age of 43±14.9 years. Ten of the patients had sporadic, and three had MEN1 syndrome-related insulinoma. During the prolonged fasting test, the patients had a mean lowest plasma glucose level of 36.4 ± 6.2 mg/dl with a simultaneous mean insulin level of 11.3 (4.4 - 214.1) mIU/L and c-peptide level of 2.8 (0.46-12.8) mcg/L. In preoperative localization studies, a lesion was detected in 11 out of 13 (84.6%) patients with upper abdominal computed tomography (CT) and 6 out of 10 patients (60%) with magnetic resonance imaging (MRI). Six patients had grade 1, and 7 patients had grade 2 neuroendocrine tumor. The whole group's mean lesion diameter was 15 (11-48) mm. The mean patient follow-up duration was 30.5 ± 23 months. Hypoglycemia recurred in none of the patients in the postoperative period, and only two patients (15.4%) developed postoperative diabetes mellitus (DM).
Conclusion
Preoperative localization rates in insulinomas increased due to non-invasive imaging methods and technological developments in recent years. This will probably cause earlier diagnosis and treatment, and pancreas preserving surgery option will be more available in most insulinoma cases.

Keywords

Insulinoma, hyperinsulinism, hypoglycemia, neuroendocrine tumor

References

• Service FJ, McMahon MM, O’Brien PC, Ballard DJ. Functioning insulinoma—incidence, recurrence, and long-term survival of patients: A 60-year study. Mayo Clin Proc. 1991 Jul;66(7):711-9. doi: 10.1016/S0025-6196(12)62083-7.
• Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER, Service FJ. Evaluation and management of adult hypoglycemic disorders: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2009 Mar;94(3):709-28. doi: 10.1210/jc.2008-1410.
• Okabayashi T, Shima Y, Sumiyoshi T, Kozuki A, Ito S, Ogawa Y, Kobayashi M, Hanazaki K. Diagnosis and management of insulinoma. World J Gastroenterol. 2013 Feb 14;19(6):829-37. doi: 10.3748/wjg.v19.i6.829.
• Brandi ML, Agarwal SK, Perrier ND, Lines KE, Valk GD, Thakker R v. Multiple endocrine neoplasia type 1: Latest insights. Endocr Rev. 2021 Mar 15;42(2):133-70. doi: 10.1210/ endrev/bnaa031.
• Liao J, Ding F, Luo W, Nie X, He Y, Li G. Using the secretion ratios of insulin and c-peptide during the 2-h oral glucose tolerance test to diagnose insulinoma. Dig Dis Sci. 2021 May;66(5):1533-9. doi: 10.1007/s10620-020-06379-z.
• Yang Y, Shi J, Zhu J. Diagnostic performance of noninvasive imaging modalities for localization of insulinoma: A meta- analysis. Eur J Radiol. 2021 Dec;145:110016. doi: 10.1016/j. ejrad.2021.110016.
• Sho H, Fukui K, Yoneda S, Toyoda S, Ozawa H, Ishibashi C, Fujita Y, Eguchi H, Kozawa J, Shimomura I. Insulinoma induces a hyperinsulinemia-mediated decrease of GLUT2 and GLP1 receptor in normal pancreatic β-cells. Biochem Biophys Res Commun. 2021 Jan 1;534:702-6. doi: 10.1016/j. bbrc.2020.11.014.
• GuW,LiuY,LiuH,YangG,GuoQ,DuJ,JinN,ZangL,Lv Z, Ba J, Mu Y, Dou J. Characteristics of glucose metabolism indexes and continuous glucose monitoring system (CGMS) in patients with insulinoma. Diabetol Metab Syndr. 2017 Mar 14;9:17. doi: 10.1186/s13098-017-0215-3.
• Lewis MA, Thompson GB, Young WF. Preoperative assessment of the pancreas in multiple endocrine neoplasia type 1. World J Surg. 2012 Jun;36(6):1375-81. doi: 10.1007/s00268-012-1539-7.
• Maggio I, Mollica V, Brighi N, Lamberti G, Manuzzi L, Ricci AD, Campana D. The functioning side of the pancreas: a review on insulinomas. J Endocrinol Invest. 2020 Feb;43(2):139-48. doi: 10.1007/s40618-019-01091-w.
• Placzkowski KA, Vella A, Thompson GB, Grant CS, Reading CC, Charboneau JW, Andrews JC, Lloyd R v., Service FJ. Secular trends in the presentation and management of functioning insulinoma at the mayo clinic, 1987-2007. J Clin Endocrinol Metab. 2009 Apr;94(4):1069-73. doi: 10.1210/ jc.2008-2031.
• Falconi M, Eriksson B, Kaltsas G, Bartsch DK, Capdevila J, Caplin M, Kos-Kudla B, Kwekkeboom D, Rindi G, KlÖppel G, Reed N, Kianmanesh R, Jensen RT. ENETS consensus guidelines update for the management of patients with functional pancreatic neuroendocrine tumors and non-functional pancreatic neuroendocrine tumors. Neuroendocrinology. 2016;103(2):153-71. doi: 10.1159/000443171.
• Belfiori G, Wiese D, Partelli S, Wächter S, Maurer E, Crippa S, Falconi M, Bartsch DK. Minimally invasive versus open treatment for benign sporadic insulinoma comparison of short-term and long-term outcomes. World J Surg. 2018 Oct;42(10):3223-30. doi: 10.1007/s00268-018-4628-4.
• Ahmadi P, Shirzad N, Shahsiah R, Hemmatabad M. Insulinoma: spectrum of clinicopathological features in a tertiary center. Istanbul Medical Journal. 2021;22(1):61-7. doi: 10.4274/imj. galenos.2021.45202.
• Ülkü A, Yalav O, Sarıtaş AG, Rencüzoğulları A, Dalcı K, Eray İC, Yağmur Ö, Akcam AT. Long-term outcomes of surgical management of insulinoma: Single Center Experience. Dicle Medical Journal. 2018;45(2):139-46. doi: 10.5798/ dicletip.424975.
• Pekalay Z. Bir seri insülinoma olgusu: On hastadaki deneyimimiz. Turk J Endocrinol Metab. 2017;21(3):85-8. doi: 10.25179/tjem.2017-56483.