Experience in the Approach to Insulinoma: A Case Series


neuroendocrine tumor

How to Cite

Victoria, Ángela, Cándelo, K., Argüello, P., Fériz, K., Casas, L., Arango, L., López, A., Martínez, V., & Guzmán, G. (2018). Experience in the Approach to Insulinoma: A Case Series. Internal Medicine and Medical Investigation Journal, 3(4). https://doi.org/10.24200/imminv.v2i4.175


Introduction: Insulinomas are rare pancreatic neuroendocrine tumors derived from beta cells responsible for insulin secretion. These tumors are typically manifested by hypoglycemia signs and symptoms, which might be non-specific leading to a delay in the diagnosis. The present study describes the experience in the approach of patients with insulinoma at Fundación Valle del Lili, Cali, Colombia.

Case Presentation: A retrospective search of patients with the diagnosis of insulinoma within the database of the pathology service was performed between March 2002 and February 2017. Parameters such as the lesion size and localization, the immunohistochemistry findings, the serum levels of glucose, the insulin and C-peptide levels, the presence of metastasis, and the development of diabetes after surgery were evaluated. A total of nine patients with a diagnosis of insulinoma were enrolled in the study. The cohort comprised of seven men and two women, aged 30–50 years. Whipple triad was present in seven patients. The most common symptom was hypoglycemia-related syncope. All patients underwent surgical resection of the tumor with subsequent resolution of the symptoms. Only one patient was diagnosed with diabetes in the postoperative period.

Conclusion: In the last 15 years, only nine cases of insulinoma were detected at the Fundación Valle del Lili, which is consistent with the low incidence of the disease. A higher frequency of the disease is noted in men, unlike that in the literature. However, other clinical and pathological features from large studies are in agreement with the current data. Nevertheless, continual experience in the management and identification of these cases is essential as common clinical manifestations may not be observed.



Grant CS. Insulinoma. Brenner’s Encycl Genet [Internet]. 2013;4:95. Available from: http://linkinghub.elsevier.com/retrieve/pii/B9780123749840008007.

Service FJ, McMahon MM, O’Brien PC, Ballard DJ. Functioning insulinoma incidence, recurrence, and longterm survival of patients: a 60 year study. Mayo Clin Proc 1991; 66:711.

Herder WWD, Schaik EV, Kwekkeboom D, Feelders RA. New therapeutic options for metastatic malignant insulinomas. Clin Endocrinol. 2011;75(3):277-284. doi:10.1111/j.1365-2265.2011.04145.x.

National Comprehensive Cancer Network (NCCN). NCCN Clinical practice guidelines in oncology. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp (Accessed on February 27, 2017).

Kulke MH, Bergsland EK, Yao JC. Glycemic Control in Patients with Insulinoma Treated with Everolimus. N Engl J Med. Doi: 2009;360(2):195–7. 10.1056/NEJMc0806740.

Edge SB, Byrd DR, Compton CC, et al. AJCC (American Joint Committee on Cancer) Cancer Staging Manual, 7th ed, Springer, New York Vol 2010, p.241.

Placzkowski KA, Vella A, Thompson GB, Grant CS, Reading CC, Charboneau JW, et al. trends in the presentation and management of functioning insulinoma at the mayo clinic, 1987-2007. J Clin Endocrinol Metab. 2009;94(4):1069–73.

Service FJ, Dale AJ, Elveback LR, Jiang NS. Insulinoma: clinical and diagnostic features of 60 consecutive cases. Mayo Clin Proc 1976; 51:417.

Dizon AM, Kowalyk S, Hoogwerf BJ. Neuroglycopenic and other symptoms in patients with insulinomas. Am J Med 1999; 106:307.

Whipple AO 1938 The surgical therapy of hyperinsulinism. J Int Chir 3:237–276.

Service FJ Diagnostic approach to adults with hypoglycemic disorders. Endocrinol Metab Clin North Am. 1999; 28:519–532, vi

Okabayashi T, Shima Y, Sumiyoshi T, et al. Diagnosis and management of insulinoma. World J Gastroenterol. 2013; 19: 829-837.

Cryer PE, Axelrod L, Grossman AB, et al. Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2009; 94: 709-728.

Bilimoria KY, Bentrem DJ, Merkow RP, et al. Application of the pancreatic adenocarcinoma staging system to pancreatic neuroendocrine tumors. J Am Coll Surg 2007; 205:558.

Gill GV, Rauf O, MacFarlane IA. Diazoxide treatment for insulinoma: a national UK survey. Postgrad Med J 1997; 73:640.

Goode PN, Farndon JR, Anderson J, et al. Diazoxide in the management of patients with insulinoma. World J Surg 1986; 10:586.

Service FJ. Hypoglycemia including hypoglycemia in neonates and children. In: Endocrinology, 3rd, DeGroot LJ (Ed), WB Saunders, Philadelphia 1995. p.160.

Romeo S, Milione M, Gatti A, et al. Complete clinical remission and disappearance of liver metastases after treatment with somatostatin analogue in a 40 year old woman.

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