How are insulinomas diagnosed?

            You probably have heard about diabetes or know a person with this disease. It is a condition of a high blood sugar level that is caused by the insulin resistance or the inability of the body to produce enough insulin. Regular health screening should be able to detect this disease early on and patients can be provided with appropriate treatment. However, insulin is not only synonymous with diabetes. Disease such as insulinoma may seem uncommon as much as diabetes but the disease can cause great discomfort to patients when it is left untreated.

            Insulinomas is a rare pancreatic beta-cell tumour that overproduces insulin. To better understand how insulinoma affects a person, we have to know a bit more about insulin itself. Insulin is a vital hormone which regulates the body’s energy supply by controlling cells and tissue to absorb energy by regulating the blood sugar. This hormone is produced by the pancreas, mostly by the beta-cell. Thus, in insulinoma, the overproduction of insulin can cause a person to have low blood glucose level. This is the total opposite of diabetes where the insulin is present but unable to be utilised by the cell’s body and causes the blood sugar level to be high.

            Insulinoma affects 1 to 4 people per million of the general population. This makes the disease quite a rare one. It is not known what causes insulinoma but it is believed due to the gene of the pancreas cell that is responsible for overproducing insulin but is not from cancer cells. This tumour often appears in people between the age of 40 to 60. People with genetic diseases such as neurofibromatosis type 1, von Hippel-Lindau syndrome and tuberous sclerosis have higher chances for acquiring insulinoma.

            Symptoms of insulinoma resemble the classic clinical sign of low blood sugar level (hypoglycaemia) such as visual disturbances such as double vision or blurred vision, headache, confusion, excessive sweating, hunger, heart palpitations, shaky hands (tremor), behavioural changes and personality changes. In certain case, it might cause seizures, loss of consciousness and coma. These signs are more prominent when a person fast. However, since symptoms of insulinoma may resemble neurologic disorder or psychiatric disorders, it can be difficult to detect insulinomas.

            To diagnose insulinomas, in an initial visit to the doctor, doctors will look for the Whipple’s triad. Whipple’s triad is a collection of symptoms that help doctors to diagnose insulinomas. Whipple’s triad consists of symptoms of low blood sugar (hypoglycaemia), blood sugar level lower than 2.2 mmol/L and the patient feel better after eating food with high amounts of sugar or after receiving glucose drip. It is worth noting that it can be difficult to diagnose insulinomas as the average time between the start of symptoms and a diagnosis is made after around 3 years. Once a doctor suspects a person with insulinoma, the patient may need to stay in hospital for a few days to allow the doctor to make observations on blood sugar level and insulin level. Fasting test is the common blood test done to check for blood sugar levels. This test usually takes 3 days or 72 hours. Imaging tests are often used to evaluate the size of the tumour and the location of the tumour. Imaging tests commonly used are ultrasound but, in some cases, CT-scan, MRI or PET scan may be used. Endoscopy procedure might be done if doctors are unsure if  it is insulinomas, especially if diagnosis is inconclusive by obtaining a small sample of the affected pancreas cells.

            Most insulinomas are not cancerous. Surgeons typically remove the tumour and this alone will resolve the issue in insulinomas that has not spread to other parts of the body. Surgery is often done via laparoscopy. However, if surgery is not feasible such as in case insulinoma that has spread to other parts of the body, other treatment options are considered. This includes drugs to control blood sugar levels such as diazoxide, specific diet, somatostatin analogue such as octreotide or lanreotide, radiofrequency ablation (RFA) and trans arterial embolization (TAE). Chemotherapy may be given to help eliminate insulinoma that has spread to other parts of the body.

            It is not known how to prevent insulinomas. The best thing a person can do is to get checked for insulinoma if they have family members with genetic conditions. The good news is, 80% of insulinomas are single, small and intact, and are able to be treated completely only with surgery. In fact, 90% of insulinomas can be removed via surgery.

            It can be concluded that insulinomas are diagnosed with hypoglycemia symptoms and fasting tests. Treatment mainly is surgery except in case of insulinomas that are unable to be removed via surgery alone. Combinations of therapy are often used to treat insulinomas that have spread to other parts of the body or malignant insulinomas. The best treatment options are only known when doctors make thorough evaluations individually. Since insulinomas are not a common disease, research is still ongoing to find ways on improving treatment options.

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