Diagnostic Evaluation of Insulinoma: A Case Report
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 12, Issue 1
Abstract
Insulinoma is the most common pancreatic neuroendocrine tumor. The clinical manifestation is diverse, some of which may cause irreversible neurological deficits due to persistent hypoglycemia. This article reports a case of a 17-year-old patient who presented with visual scotoma, somnolence and loss of consciousness with blood glucose documentation of 15 mg / dL. He was admitted and underwent imaging tests. Tomography and Magnetic Resonance imaging did not clearly identify the pancreatic lesion, but tumor lesions were identified after arterial stimulation with calcium. Patient was submitted to surgical enucleation by laparotomy. In this context, there is still much discussion about the optimal sequence of exams for the exact tumor location. However, the use of less invasive exams such as arterial calcium stimulation is essential for adequate surgical resection.Insulinoma is the most common pancreatic-producing neuroendocrine tumor, with an estimated incidence of 0.4% in the population and accounts for 70% to 75% of the causes of hyperinsulinemia. Most insulinomas originate sporadically (90%), about 5% to 10% of cases are associated with hereditary syndromes, such as Multiple Endocrine Neoplasia type 1 (MEN1) and less than 10% of lesions are malignant [1,2]. Lesions generally occur throughout the pancreas, with a slight predominance of head location [3]. Up to 90% of the lesions are smaller than 2 cm and larger lesions, as well as malignant lesions, tend to have more severe symptoms [4]. In 1938, Whipple defined the classical manifestations of patients with insulinoma. Whipple’s triad consists of: neuroglycopenic symptoms, resolution of symptoms with glucose administration and serum glucose levels < 40 mg / dl and is present in up to 90% of patients [5]. The duration of symptoms until diagnosis varies from some months and even years. Several laboratory methods and diagnostic imaging methods have been suggested for an early evaluation in suspected patients.In this context, this intense discussion of diagnostic methods has been supported by the fact that tumor localization is extremely important for evaluation and surgical programming [6]. Although most of the lesions can be identified by Computed Tomography (CT), other diagnostic methods have gained importance, such as somatostatin analogue guided scintigraphy and arterial calcium stimulation [7]. From a clinical case with classic symptomatology, but with difficulty locating the tumor, we reviewed the literature and described a flowchart for preoperative diagnostic propaedeutics for insulinoma localization.
Authors and Affiliations
Maximilian Pinho Schwermann, Matheus de Souza Mendes, André Nunes Benevides, Francisco Julimar Correiade Menezes, José Eudes Bastos Pinho
Keywords
Related Articles
- EP ID EP592724
- DOI 10.26717/BJSTR.2018.12.002209
- Views 183
- Downloads 0
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