Presentation, diagnostic features and glucose handling in a monocentric series of insulinomas
Background: New aspects have emerged in the clinical and diagnostic scenarios of insulinoma: current guidelines have lowered the diagnostic insulin threshold to 3 µU/ml in the presence of hypoglycemia (
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| Veröffentlicht in: | Journal of endocrinological investigation 2013-10, Vol.36 (9), p.753-758 |
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| container_title | Journal of endocrinological investigation |
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| creator | Toaiari, M. Davì, M. V. Dalle Carbonare, L. Boninsegna, L. Castellani, C. Falconi, M. Francia, G. |
| description | Background:
New aspects have emerged in the clinical and diagnostic scenarios of insulinoma: current guidelines have lowered the diagnostic insulin threshold to 3 µU/ml in the presence of hypoglycemia ( |
| doi_str_mv | 10.3275/8942 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_1449771662</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1449771662</sourcerecordid><originalsourceid>FETCH-LOGICAL-p1562-81f25840360c9ca96f2ab4cdc45b7b300931ffeea2849fcf5884fbea210fe9093</originalsourceid><addsrcrecordid>eNo1kE1LAzEURYMotrb-BclGcOFovmaSLKX4BQVd6FJCJpPUlJmkJjML_70pravH5Zz3eFwAlhjdUcLreyEZOQFzzAmqBBXNKZgjKnHFkOQzcJHzFiHKqeDnYEZogwSn9Rx8vSebbRj16GO4hZ3XmxDz6A10Vo9TgVCHDm76ycRs4XcJvQ8b6APUcIghmrKcip5t8kWOrqA8FScOOi_BmdN9tpfHuQCfT48fq5dq_fb8unpYVztcN6QS2JFaMFS-MtJo2TiiW2Y6w-qWtxQhSbFz1moimHTG1UIw15aIkbOy0AW4Odzdpfgz2TyqwWdj-14HG6esMGOSc9w0pKhXR3VqB9upXfKDTr_qv5IiXB-EXFDY2KS2cUqhvK8wUvuq1b5q-gc_mm48</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1449771662</pqid></control><display><type>article</type><title>Presentation, diagnostic features and glucose handling in a monocentric series of insulinomas</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Toaiari, M. ; Davì, M. V. ; Dalle Carbonare, L. ; Boninsegna, L. ; Castellani, C. ; Falconi, M. ; Francia, G.</creator><creatorcontrib>Toaiari, M. ; Davì, M. V. ; Dalle Carbonare, L. ; Boninsegna, L. ; Castellani, C. ; Falconi, M. ; Francia, G.</creatorcontrib><description>Background:
New aspects have emerged in the clinical and diagnostic scenarios of insulinoma: current guidelines have lowered the diagnostic insulin threshold to 3 µU/ml in the presence of hypoglycemia (<55 mg/dl); post-prandial hypoglycemia has been reported as the only presenting symptom; preexisting diabetes mellitus (DM) was recognized in some patients.
Aim:
To evaluate clinical features, diagnostic criteria and glucose metabolic profile in a monocentric series of patients affected by insulinomas including two subgroups: sporadic and multiple endocrine neoplasia type-1 syndrome (MEN-1).
Subjects and methods:
Clinical, pathological and biochemical data regarding 33 patients were analyzed.
Results:
following the current guidelines the 72-h fasting test was initially positive in all cases but one. In this case the test, initially negative, became positive after a 2-yr follow-up. Nadir insulin level was ≥3 µU/ml but <6 µU/ml in 3 patients and ≥6 µU/ml in the remaining 30 cases. At presentation, 27 patients (82%) reported only fasting symptoms, 3 (9%) only post-prandial and 3 (9%) both. Seven cases (21%) had previously been affected by type 2 DM or impaired glucose metabolism.
Conclusions:
In our series the new cut-off of insulin increased the sensitivity of the 72-h fasting test from 87% to 97%. The absence of hypoglycemia during the test cannot definitively rule out the diagnosis and the test should be repeated in every highly suspicious case. Post-prandial hypoglycemia can be the only presenting symptom. DM may be associated with the occurrence of insulinoma. So that a possible diagnosis of insulinoma must not be ignored if previous impaired glucose handling is evident.</description><identifier>ISSN: 0391-4097</identifier><identifier>EISSN: 1720-8386</identifier><identifier>DOI: 10.3275/8942</identifier><identifier>PMID: 23608735</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adolescent ; Adult ; Aged ; Blood Glucose - metabolism ; Diabetes Mellitus, Type 2 - complications ; Endocrinology ; Fasting - adverse effects ; Female ; Glucose Tolerance Test ; Humans ; Hypoglycemia - complications ; Hypoglycemia - diagnosis ; Insulin - blood ; Insulinoma - blood ; Insulinoma - complications ; Insulinoma - diagnosis ; Insulinoma - pathology ; Male ; Medicine ; Medicine & Public Health ; Metabolic Diseases ; Middle Aged ; Multiple Endocrine Neoplasia Type 1 - blood ; Multiple Endocrine Neoplasia Type 1 - complications ; Multiple Endocrine Neoplasia Type 1 - diagnosis ; Original Article ; Pancreatic Neoplasms - blood ; Pancreatic Neoplasms - complications ; Pancreatic Neoplasms - diagnosis ; Pancreatic Neoplasms - pathology ; Postprandial Period ; Retrospective Studies</subject><ispartof>Journal of endocrinological investigation, 2013-10, Vol.36 (9), p.753-758</ispartof><rights>Italian Society of Endocrinology (SIE) 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-p1562-81f25840360c9ca96f2ab4cdc45b7b300931ffeea2849fcf5884fbea210fe9093</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.3275/8942$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.3275/8942$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27922,27923,41486,42555,51317</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23608735$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Toaiari, M.</creatorcontrib><creatorcontrib>Davì, M. V.</creatorcontrib><creatorcontrib>Dalle Carbonare, L.</creatorcontrib><creatorcontrib>Boninsegna, L.</creatorcontrib><creatorcontrib>Castellani, C.</creatorcontrib><creatorcontrib>Falconi, M.</creatorcontrib><creatorcontrib>Francia, G.</creatorcontrib><title>Presentation, diagnostic features and glucose handling in a monocentric series of insulinomas</title><title>Journal of endocrinological investigation</title><addtitle>J Endocrinol Invest</addtitle><addtitle>J Endocrinol Invest</addtitle><description>Background:
New aspects have emerged in the clinical and diagnostic scenarios of insulinoma: current guidelines have lowered the diagnostic insulin threshold to 3 µU/ml in the presence of hypoglycemia (<55 mg/dl); post-prandial hypoglycemia has been reported as the only presenting symptom; preexisting diabetes mellitus (DM) was recognized in some patients.
Aim:
To evaluate clinical features, diagnostic criteria and glucose metabolic profile in a monocentric series of patients affected by insulinomas including two subgroups: sporadic and multiple endocrine neoplasia type-1 syndrome (MEN-1).
Subjects and methods:
Clinical, pathological and biochemical data regarding 33 patients were analyzed.
Results:
following the current guidelines the 72-h fasting test was initially positive in all cases but one. In this case the test, initially negative, became positive after a 2-yr follow-up. Nadir insulin level was ≥3 µU/ml but <6 µU/ml in 3 patients and ≥6 µU/ml in the remaining 30 cases. At presentation, 27 patients (82%) reported only fasting symptoms, 3 (9%) only post-prandial and 3 (9%) both. Seven cases (21%) had previously been affected by type 2 DM or impaired glucose metabolism.
Conclusions:
In our series the new cut-off of insulin increased the sensitivity of the 72-h fasting test from 87% to 97%. The absence of hypoglycemia during the test cannot definitively rule out the diagnosis and the test should be repeated in every highly suspicious case. Post-prandial hypoglycemia can be the only presenting symptom. DM may be associated with the occurrence of insulinoma. So that a possible diagnosis of insulinoma must not be ignored if previous impaired glucose handling is evident.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Blood Glucose - metabolism</subject><subject>Diabetes Mellitus, Type 2 - complications</subject><subject>Endocrinology</subject><subject>Fasting - adverse effects</subject><subject>Female</subject><subject>Glucose Tolerance Test</subject><subject>Humans</subject><subject>Hypoglycemia - complications</subject><subject>Hypoglycemia - diagnosis</subject><subject>Insulin - blood</subject><subject>Insulinoma - blood</subject><subject>Insulinoma - complications</subject><subject>Insulinoma - diagnosis</subject><subject>Insulinoma - pathology</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metabolic Diseases</subject><subject>Middle Aged</subject><subject>Multiple Endocrine Neoplasia Type 1 - blood</subject><subject>Multiple Endocrine Neoplasia Type 1 - complications</subject><subject>Multiple Endocrine Neoplasia Type 1 - diagnosis</subject><subject>Original Article</subject><subject>Pancreatic Neoplasms - blood</subject><subject>Pancreatic Neoplasms - complications</subject><subject>Pancreatic Neoplasms - diagnosis</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Postprandial Period</subject><subject>Retrospective Studies</subject><issn>0391-4097</issn><issn>1720-8386</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo1kE1LAzEURYMotrb-BclGcOFovmaSLKX4BQVd6FJCJpPUlJmkJjML_70pravH5Zz3eFwAlhjdUcLreyEZOQFzzAmqBBXNKZgjKnHFkOQzcJHzFiHKqeDnYEZogwSn9Rx8vSebbRj16GO4hZ3XmxDz6A10Vo9TgVCHDm76ycRs4XcJvQ8b6APUcIghmrKcip5t8kWOrqA8FScOOi_BmdN9tpfHuQCfT48fq5dq_fb8unpYVztcN6QS2JFaMFS-MtJo2TiiW2Y6w-qWtxQhSbFz1moimHTG1UIw15aIkbOy0AW4Odzdpfgz2TyqwWdj-14HG6esMGOSc9w0pKhXR3VqB9upXfKDTr_qv5IiXB-EXFDY2KS2cUqhvK8wUvuq1b5q-gc_mm48</recordid><startdate>201310</startdate><enddate>201310</enddate><creator>Toaiari, M.</creator><creator>Davì, M. V.</creator><creator>Dalle Carbonare, L.</creator><creator>Boninsegna, L.</creator><creator>Castellani, C.</creator><creator>Falconi, M.</creator><creator>Francia, G.</creator><general>Springer International Publishing</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>201310</creationdate><title>Presentation, diagnostic features and glucose handling in a monocentric series of insulinomas</title><author>Toaiari, M. ; Davì, M. V. ; Dalle Carbonare, L. ; Boninsegna, L. ; Castellani, C. ; Falconi, M. ; Francia, G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p1562-81f25840360c9ca96f2ab4cdc45b7b300931ffeea2849fcf5884fbea210fe9093</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Blood Glucose - metabolism</topic><topic>Diabetes Mellitus, Type 2 - complications</topic><topic>Endocrinology</topic><topic>Fasting - adverse effects</topic><topic>Female</topic><topic>Glucose Tolerance Test</topic><topic>Humans</topic><topic>Hypoglycemia - complications</topic><topic>Hypoglycemia - diagnosis</topic><topic>Insulin - blood</topic><topic>Insulinoma - blood</topic><topic>Insulinoma - complications</topic><topic>Insulinoma - diagnosis</topic><topic>Insulinoma - pathology</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metabolic Diseases</topic><topic>Middle Aged</topic><topic>Multiple Endocrine Neoplasia Type 1 - blood</topic><topic>Multiple Endocrine Neoplasia Type 1 - complications</topic><topic>Multiple Endocrine Neoplasia Type 1 - diagnosis</topic><topic>Original Article</topic><topic>Pancreatic Neoplasms - blood</topic><topic>Pancreatic Neoplasms - complications</topic><topic>Pancreatic Neoplasms - diagnosis</topic><topic>Pancreatic Neoplasms - pathology</topic><topic>Postprandial Period</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Toaiari, M.</creatorcontrib><creatorcontrib>Davì, M. V.</creatorcontrib><creatorcontrib>Dalle Carbonare, L.</creatorcontrib><creatorcontrib>Boninsegna, L.</creatorcontrib><creatorcontrib>Castellani, C.</creatorcontrib><creatorcontrib>Falconi, M.</creatorcontrib><creatorcontrib>Francia, G.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of endocrinological investigation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Toaiari, M.</au><au>Davì, M. V.</au><au>Dalle Carbonare, L.</au><au>Boninsegna, L.</au><au>Castellani, C.</au><au>Falconi, M.</au><au>Francia, G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Presentation, diagnostic features and glucose handling in a monocentric series of insulinomas</atitle><jtitle>Journal of endocrinological investigation</jtitle><stitle>J Endocrinol Invest</stitle><addtitle>J Endocrinol Invest</addtitle><date>2013-10</date><risdate>2013</risdate><volume>36</volume><issue>9</issue><spage>753</spage><epage>758</epage><pages>753-758</pages><issn>0391-4097</issn><eissn>1720-8386</eissn><abstract>Background:
New aspects have emerged in the clinical and diagnostic scenarios of insulinoma: current guidelines have lowered the diagnostic insulin threshold to 3 µU/ml in the presence of hypoglycemia (<55 mg/dl); post-prandial hypoglycemia has been reported as the only presenting symptom; preexisting diabetes mellitus (DM) was recognized in some patients.
Aim:
To evaluate clinical features, diagnostic criteria and glucose metabolic profile in a monocentric series of patients affected by insulinomas including two subgroups: sporadic and multiple endocrine neoplasia type-1 syndrome (MEN-1).
Subjects and methods:
Clinical, pathological and biochemical data regarding 33 patients were analyzed.
Results:
following the current guidelines the 72-h fasting test was initially positive in all cases but one. In this case the test, initially negative, became positive after a 2-yr follow-up. Nadir insulin level was ≥3 µU/ml but <6 µU/ml in 3 patients and ≥6 µU/ml in the remaining 30 cases. At presentation, 27 patients (82%) reported only fasting symptoms, 3 (9%) only post-prandial and 3 (9%) both. Seven cases (21%) had previously been affected by type 2 DM or impaired glucose metabolism.
Conclusions:
In our series the new cut-off of insulin increased the sensitivity of the 72-h fasting test from 87% to 97%. The absence of hypoglycemia during the test cannot definitively rule out the diagnosis and the test should be repeated in every highly suspicious case. Post-prandial hypoglycemia can be the only presenting symptom. DM may be associated with the occurrence of insulinoma. So that a possible diagnosis of insulinoma must not be ignored if previous impaired glucose handling is evident.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>23608735</pmid><doi>10.3275/8942</doi><tpages>6</tpages></addata></record> |
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| subjects | Adolescent Adult Aged Blood Glucose - metabolism Diabetes Mellitus, Type 2 - complications Endocrinology Fasting - adverse effects Female Glucose Tolerance Test Humans Hypoglycemia - complications Hypoglycemia - diagnosis Insulin - blood Insulinoma - blood Insulinoma - complications Insulinoma - diagnosis Insulinoma - pathology Male Medicine Medicine & Public Health Metabolic Diseases Middle Aged Multiple Endocrine Neoplasia Type 1 - blood Multiple Endocrine Neoplasia Type 1 - complications Multiple Endocrine Neoplasia Type 1 - diagnosis Original Article Pancreatic Neoplasms - blood Pancreatic Neoplasms - complications Pancreatic Neoplasms - diagnosis Pancreatic Neoplasms - pathology Postprandial Period Retrospective Studies |
| title | Presentation, diagnostic features and glucose handling in a monocentric series of insulinomas |
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