Insulinoma history and symptoms: Difference between revisions

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{{Insulinoma}}


==Overview==
==Overview==
A positive long history of frequent episodes of [[altered mental status]]/[[confusion]], [[visual]] disturbances and [[sweating]] is suggestive of insulinoma. The most common symptoms of insulinoma include [[altered mental status]]/[[confusion]], [[visual]] disturbances like [[blurred vision]]/[[diplopia]], [[sweating]], [[hyperphagia]] and [[coma]]. Less common symptoms of insulinoma include [[palpitations]], [[seizures]], [[tremor|tremors]], behavioral disturbances and [[weakness]].


==History==
==History and Symptoms==
When evaluating a patient for insulinoma, you should take a detailed history of the presenting symptom (onset, duration, and progression), other associated symptoms, and a thorough past medical history review. Other specific areas of focus when obtaining the history are:
 
Review of any family history of predisposing genetic disorders such as [[multiple endocrine neoplasia type 1]] or [[von Hippel-Lindau syndrome]].


==Symptoms==
Insulinoma patients usually present with history of [[hypoglycemic]] episodes occurring over time with a recent increase in frequency and without any other cause known to cause [[hypoglycemia]] like exogenous insulin and [[Hypoglycemic agent|hypoglycemic agent<nowiki/>s]]. The following are the history and symptoms of insulinoma:
*Insulinoma is most common cause of hypoglycemia amongst other causes of endogenous hyperinsulism.
===History===
*Insulinoma secrete insulin in intermittently resulting in episodica nature of hypoglycemia.
*Common autonomic symptoms of an insulinoma include:<ref name="pmid23430217">{{cite journal| author=Okabayashi T, Shima Y, Sumiyoshi T, Kozuki A, Ito S, Ogawa Y et al.| title=Diagnosis and management of insulinoma. | journal=World J Gastroenterol | year= 2013 | volume= 19 | issue= 6 | pages= 829-37 | pmid=23430217 | doi=10.3748/wjg.v19.i6.829 | pmc=PMC3574879 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23430217  }} </ref>
:*[[Diaphoresis]]
:*[[Tremor]]
:*[[Palpitations]]


*Common neuroglycopenenic symptoms include:<ref name="pmid23430217">{{cite journal| author=Okabayashi T, Shima Y, Sumiyoshi T, Kozuki A, Ito S, Ogawa Y et al.| title=Diagnosis and management of insulinoma. | journal=World J Gastroenterol | year= 2013 | volume= 19 | issue= 6 | pages= 829-37 | pmid=23430217 | doi=10.3748/wjg.v19.i6.829 | pmc=PMC3574879 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23430217 }} </ref>
Patients with insulinoma may have a positive history of:
:*[[Confusion]]
*Frequent episodes of [[altered mental status]]/[[confusion]]
:*Behavioral change
*[[Visual]] disturbances
:*Personality change
*[[Sweating]]
:*[[Visual disturbance]]
*Negative history for exogenous [[insulin]] or oral hypoglycemic agents such as [[Sulfonylureas]]
:*[[Seizures]]  
===Common Symptoms===
:*[[Coma]]
Common symptoms of insulinoma include: <ref name="pmid18703061">{{cite journal| author=Metz DC, Jensen RT| title=Gastrointestinal neuroendocrine tumors: pancreatic endocrine tumors. | journal=Gastroenterology | year= 2008 | volume= 135 | issue= 5 | pages= 1469-92 | pmid=18703061 | doi=10.1053/j.gastro.2008.05.047 | pmc=2612755 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18703061  }} </ref><ref name="pmid9735690">{{cite journal| author=Boukhman MP, Karam JH, Shaver J, Siperstein AE, Duh QY, Clark OH| title=Insulinoma--experience from 1950 to 1995. | journal=West J Med | year= 1998 | volume= 169 | issue= 2 | pages= 98-104 | pmid=9735690 | doi= | pmc=1305178 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9735690 }} </ref>
*[[Altered mental status]]/[[confusion]]
*[[Visual disturbance|Visual disturbances]] like [[blurred vision]]/[[diplopia]]
*[[Sweating]]
*[[Hyperphagia]]
*[[Coma]]


*Common symptoms resulting from the catecholaminergic response to [[hypoglycemia]]:  
===Less Common Symptoms===
:*Tremulousness
Less common symptoms of insulinoma include
:*[[Palpitations]]
*[[Palpitations]]
:*[[Tachycardia]]
*[[Seizures]]
:*[[Sweating]]  
*[[Tremor|Tremors]]
:*[[Hunger]]
*Behavioral disturbances
:*[[Anxiety]]
*[[Weakness]]
:*[[Nausea]]
{| class="wikitable" style="text-align:center"
| colspan="2" style="background: #4479BA; color: #FFFFFF; " align="center" |'''Neuroglycopenic symptoms'''
|-
| style="background: #DCDCDC;" align="center" |[[Visual disturbance]]s
| style="background: #F5F5F5;" align="center" |59%
|-
| style="background: #DCDCDC;" align="center" |[[Altered mental status]]/[[Confusion]]
| style="background: #F5F5F5;" align="center" |75-80%
|-
| style="background: #DCDCDC;" align="center" |Behavioral problems
|36%
|-
| style="background: #DCDCDC;" align="center" |[[Weakness]]
| style="background: #F5F5F5;" align="center" |24-32%
|-
| style="background: #DCDCDC;" align="center" |[[Coma]]
| style="background: #F5F5F5;" align="center" |47%
|-
| style="background: #DCDCDC;" align="center" |[[Seizures]]
| style="background: #F5F5F5;" align="center" |36%
|-
| colspan="2" style="background: #4479BA; color: #FFFFFF; " align="center" |'''Sympathetic or Adrenergic symptoms'''
|-
| style="background: #DCDCDC;" align="center" |[[Sweating]]
| style="background: #F5F5F5;" align="center" |12-69%
|-
| style="background: #DCDCDC;" align="center" |[[Palpitations]]
| style="background: #F5F5F5;" align="center" |10-12%
|-
| style="background: #DCDCDC;" align="center" |[[Tremors]]
| style="background: #F5F5F5;" align="center" |17-24%
|-
| style="background: #DCDCDC;" align="center" |[[Hyperphagia]]/[[Obesity]]
| style="background: #F5F5F5;" align="center" |25-50%
|}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}
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Latest revision as of 15:25, 5 December 2017


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]

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Overview

A positive long history of frequent episodes of altered mental status/confusion, visual disturbances and sweating is suggestive of insulinoma. The most common symptoms of insulinoma include altered mental status/confusion, visual disturbances like blurred vision/diplopia, sweating, hyperphagia and coma. Less common symptoms of insulinoma include palpitations, seizures, tremors, behavioral disturbances and weakness.

History and Symptoms

Insulinoma patients usually present with history of hypoglycemic episodes occurring over time with a recent increase in frequency and without any other cause known to cause hypoglycemia like exogenous insulin and hypoglycemic agents. The following are the history and symptoms of insulinoma:

History

Patients with insulinoma may have a positive history of:

Common Symptoms

Common symptoms of insulinoma include: [1][2]

Less Common Symptoms

Less common symptoms of insulinoma include

Neuroglycopenic symptoms
Visual disturbances 59%
Altered mental status/Confusion 75-80%
Behavioral problems 36%
Weakness 24-32%
Coma 47%
Seizures 36%
Sympathetic or Adrenergic symptoms
Sweating 12-69%
Palpitations 10-12%
Tremors 17-24%
Hyperphagia/Obesity 25-50%

References

  1. ↑ Metz DC, Jensen RT (2008). "Gastrointestinal neuroendocrine tumors: pancreatic endocrine tumors". Gastroenterology. 135 (5): 1469–92. doi:10.1053/j.gastro.2008.05.047. PMC 2612755. PMID 18703061.
  2. ↑ Boukhman MP, Karam JH, Shaver J, Siperstein AE, Duh QY, Clark OH (1998). "Insulinoma--experience from 1950 to 1995". West J Med. 169 (2): 98–104. PMC 1305178. PMID 9735690.

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