Updates in the diagnostics of insulinoma

Abstract

Introduction: Insulinomas are rare neoplasias with incidence of 1-4 cases per million population annually, but still most common from pancreatic neuroendocrine tumours.Purpose: An analysis of the sensitivity and specificity of insulinoma diagnostic methods. Material and methods: Here are discussed diagnostic data of 15 patients with insulinoma between 1993 and 2021 from clinic no. 1 of the surgery department no. 2. Diagnosis rely on clinical presentation, laboratory findings (glycemic profile, glucose levels during hypoglycemic accesses, convulsive attacks, after 40% glucose solution administration, as well as levels of seric insulin and C-peptide) and imagistic methods as ultrasonography (Figure. 2), CT (Figure.3), MRI (Figure .4). Results: Clinical presentation are dominated by neuropsychic symptoms 13 (86,6%) cases, followed by adrenergic symptoms 10 (66,7%) cases, digestive symptoms 8 (53,3%) cases, and cushingoid manifestations 3 (20%) cases (Figure 1). Glucose levels during hypoglycemic attacks were between 2,0-3,0 mmol/l, after 40% glucose solution infusion - 3,8-5,8 mmol/l. Median level of Cpeptide was 4,6 ng/l , of insulin was 32,45 µmol/l. Imagistic was found tumours between 0,8 and 2,5 cm in size, 10 (66,4%) cases in corporeal site (Figure.2 , Figure.4) and 5 (33,6%) cases in caudal site (Figure.3). Conclusions: The diagnostic of an insulinoma is still a dilemma, relying mostly on clinical manifestations and laboratory findings while there are no unanimously accepted imagistical criteria.