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Vol. 24, Art. 76 (pp. 1111-1125)    |    2023       

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Insulinoma - clinical and diagnostical features and epilepsy mask

Ulitin A.Yu.1,2, Vasilenko A.V.1,2, Mitrofanova L.B.1, Razmogolova O.Yu.1, Makhortova S.A.2, Chudievich S.N.2, Chistova I.V.2

1Almazov National Medical Research Centre
2 North-Western State Medical University named after I. I. Mechnikov

Brief summary

Insulinoma is a rare neuroendocrine tumor feature in gresist an thy per glycemia that leads to neuro glycopenia and vegetative symptoms. Non specificity of the clinical presentation results in certain difficulties in diagnosis of the disease; often clinical physicians mistakenly diagnose the debut of the epilepsy which leads to the prescription of an ineffective therapy and worsening of a life prognosis for a patient. Diagnosis of insulinomas is still based on the Whipple triad (hypoglycemia, hypoglycemia associated symptoms and improvement of the symptoms after the glucose injection) and also on running the 72-hour starving test and group of instrumental diagnosis such as endoscopic ultrasonography, PET/CT with exendin-4, 68-Ga-DOTA or 18-F-DOFA.These methods are characterized by high sensibility and specificity, some of them give an opportunity to minimize surgery treatment and reduce the risks of postoperative complications.A key point is morphologic diagnosis by immunohistochemical analysis with a purpose to verify the diagnosis and reveal the sensibility to the target therapy. Treatment of an insulinoma generally is surgical, nevertheless it is possible to apply pharmacological treatment such as potassium channel activators (diazoxide), somatostatin analogues (lanreotide, octreotide) that reduce the synthesis of an insulin. Target therapy is also used by the way of mTOR inhibitors(everolimus, sunitinib). Therefore, actual specter of diagnostical tests and treatment is very large. Though concerning nonspecific clinical presentation and some features of diagnostical methods it is quite easy to miss this disease which will play the crucial role in a life prognosis for a patient.


Key words

insulinoma, epilepsy, hypoglycemia, hyperinsulinism, mTOR inhibitors

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