Experience in the Approach to Insulinoma: A Case Series

Ángela María Victoria, Karen Daniela Cándelo, Pedro Tomás Argüello, Karen Milena Fériz, Luz Ángela Casas, Luis Guillermo Arango, Alejandro López, Veline Martínez, Guillermo Edinson Guzmán

Abstract

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.

Keywords

Insulinoma; neuroendocrine tumor; hypoglycemia; hyperinsulinism

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