Updated: 4/13/2017

Insulinoma

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  • A referal patient presents with intermitten neurologic abnormalities associated with hypoglycemia. The patient has an attack while in the office. You draw labs at the time. The attack is relieved by giving glucose. A week later the labs come back with a low serum glucose, a high insulin level, and a high C-peptide.
Introduction
  • Most common islet cell tumor
  • Due to hyperplasia of insulin producing B-cells
  • 90% benign
  • Whipple Triad
    • hypoglycemia
    • CNS symptoms from hypoglycemia
    • administration of glucose resolves symptoms
Presentation
  • Symptoms of hypoglycemia
Evaluation
  • Labs will show
    • low blood glucose
    • high serum insulin
    • high C-peptide
  • Insulin glucose ratio > 0.4
  • Increase in C-peptide
  • Urine/serum sulfonylureas (factitious disorder)
Treatment
  • Enucleate
 

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