Insulinoma

Insulinoma is a rare, usually benign neuroendocrine tumor of endocrine cells ( islets of Langerhans ) of the pancreas, where insulin is produced and increasingly making itself felt by recurrent hypoglycaemia. Mostly it is an adenoma.

Occurrence

Insulinoma is the most common endocrine tumor of the pancreas with an overproduction of insulin or proinsulin. The benign in 90 % tumor occurs in women twice as often as in men. The incidence is 2-4:1000000 per year. Maximum is at about the age of 50 years. However, it can be affected every age.

Veterinary Medicine

Insulinomas are the most common tumors in ferrets. There, they occur at a frequency of 10 to 20%.

Pathology

Histologically, there is an insulin-producing neuroendocrine neoplasm of B- cells of the islets of Langerhans of the pancreas in the form of Inselzelladenoms. In about 10 to 15 % of cases an adenocarcinoma is present, and it can then be usually detected liver metastases.

Symptoms

It is repeated for hypoglycemia, which is characterized by food cravings, disturbances of consciousness, dizziness, seizures, sweating and weight gain (through the food cravings ) makes noticeable. Untreated, recurrent hypoglycaemia may lead to CNS damage.

Typical is the Whipple 's triad:

  • Detection of hypoglycemia (blood glucose <45 mg / dl; <2.5 mmol / l)
  • Coexistence of hypoglycemia signs
  • Rapid elimination of symptoms after carbohydrate intake

Diagnostics

  • Blood glucose measurements repeatedly lowered blood glucose levels to 40 mg / dl ( = 2.2 mmol / l)
  • Especially after prolonged fasting or strenuous exercise
  • The insulin concentration in the blood is relative to the blood glucose level by unrestrained insulin secretion to high
  • By the increased production of insulin and the C- peptide is increased, which can be detected in serum

Differential Diagnosis

  • The factitious hypoglycaemia, the intentional causing of a hypo, represents an important differential diagnosis in all hypoglycemia that occur in diabetics and non-diabetics.
  • Hypoglycaemia in therapy of diabetes mellitus caused by hypoglycemic drugs.

Therapy

Treatment of choice is surgical removal of the tumor, may advance with diazoxide or lanreotide / octreotide pharmacological inhibition of insulin secretion can be tried. Also, a cytostatic treatment with streptozotocin comes into question.

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