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Insulinoma : Symptoms, Causes, Diagnosis and Treatment

What is Insulinoma?

An insulinoma is a small tumor in the pancreas that produces an excess amount of insulin. In most cases, the tumor isn?t cancerous. Most insulinomas are less than 2 centimeters in diameter.

The pancreas is an endocrine organ located behind your stomach. One of its functions is to produce hormones that control the level of sugar in your bloodstream, such as insulin. Normally, the pancreas stops creating insulin when your blood sugar drops too low. This allows your blood sugar levels to return to normal. When an insulinoma forms in your pancreas, however, it will continue to produce insulin, even when your blood sugar is too low. This can lead to severe hypoglycemia, or low blood sugar. Hypoglycemia is a dangerous condition that can cause blurred vision, lightheadedness, and unconsciousness. It can also be life-threatening.

An insulinoma usually needs to be surgically removed. Once the tumor is removed, complete recovery is very likely. An insulinoma is a rare tumor of the pancreas. It?s made of calls called beta islet cells, the same ones in the pancreas the make insulin and control your blood sugar. Normally, your pancreas makes more insulin when your blood sugar is high and less when your blood sugar is low. But an insulinoma constantly makes insulin, even when your blood sugar gets too low.

You might hear an insulinoma called a "neuroendocrine tumor" because it starts in special cells in your body called neuroendocrine cells. These tumors are usually small (less than an inch), and almost all of them are not cancer. In most cases, surgery can cure them.

Insulinoma belongs under the category of Tumour . Generally Male, Female are the victim of the Insulinoma. Seriousness of this disease is Medium.

Symptoms of Insulinoma are :

  • Vision problems, such as blurred vision, double vision or loss of peripheral vision
  • Double vision is the perception of two images of a single object seen adjacent to each other (horizontally, vertically, or obliquely) or overlapping. Diplopia is the medical term for double vision. Polyplopia is the perception of three or more images of a single object overlapping each other.

    Double vision is called "monocular" when the double image is perceived by an eye that is tested alone. In "binocular" double vision, each eye sees a single image when tested alone, but a double image is present when both eyes are open.

  • hunger
  • mood swings
  • Irritability
  • Weight gain
  • Weight gain can result from an increase in body fluid, muscle mass, or fat. An increase in body fluid can come from medications, fluid and salt retention, intravenous fluid infusion, kidney or heart failure. An increase in muscle mass is commonly seen with exercising. An increase in body fat is commonly seen as a result of diet or lack of exercise as the body converts muscle to fat. An excessive weight gain is referred to as obesity. Obesity is a function of environmental (diet, exercise, lifestyle, etc.), hormonal, and inherited (genetic) factors in varying degrees. Weight gain is a normal part of pregnancy.

  • Dizziness
  • lethargy
  • Delirium and confusion
  • A faster heartbeat
  • A rapid or fast heartbeat is when your heart is beating faster than normal. A normal heart rate is 60 to 100 beats per minute. Tachycardia is considered a heart rate of greater than 100 beats per minute.
    If you are exercising, or performing any kind of activity, your heart will normally beat faster. This allows your heart to pump blood throughout your body, to provide oxygen to the tissues.
    If you are experiencing fear, anxiety or stress, your heart rate will increase.

    People who can feel their heartbeat, or flutter, may be experiencing palpitations. This may be due to stress, anxiety, medications, or it may be a sign of a serious heart condition. If you experience palpitations, you should report this to your healthcare provider.

  • sweating
  • Excessive sweating is when you sweat more than you might expect based on the surrounding temperature or your activity level or stress. Excessive sweating can disrupt daily activities and cause social anxiety or embarrassment.

    Excessive sweating, or hyperhidrosis (hi-pur-hi-DROE-sis), can affect your entire body or just certain areas, particularly your palms, soles, underarms or face. The type that typically affects the hands and feet causes at least one episode a week, during waking hours.

  • Fatigue/weakness
  • Weakness

    Weakness is when strength is decreased and extra effort is needed to move a certain part of the body or the entire body. Weakness is due to loss of muscle strength. Weakness can be a big part of why cancer patients feel fatigue.

    Fatigue

    Fatigue is an extreme feeling of tiredness or lack of energy, often described as being exhausted. Fatigue is something that lasts even when a person seems to be getting enough sleep. It can have many causes, including working too much, having disturbed sleep, stress and worry, not having enough physical activity, and going through an illness and its treatment.

  • Severe Headache
  • Headaches are a common health problem ? most people experience them at some time.

    Factors that lead to headaches may be:

    Frequent or severe headaches can affect a person?s quality of life. Knowing how to recognize the cause of a headache can help a person take appropriate action.

    Causes

    Insulinoma can be caused due to:

    Doctors don?t know exactly why people get insulinomas. The tumors typically show up without warning.

    When you eat food, the pancreas creates insulin. Insulin is a hormone that helps your body store the sugar from your food. Once the sugar has been absorbed, the pancreas stops producing insulin. This process usually keeps blood sugar levels stable. However, it can be disrupted when an insulinoma develops. The tumor continues to produce insulin even when your blood sugar drops too low. This can lead to hypoglycemia, a serious condition characterized by low blood sugar levels.

    It?s not clear why some people get insulinomas. Women are slightly more likely to have them than men, and most people get them between ages 40 and 60. You?re also more likely to have an insulinoma if you have certain genetic diseases, including:

    What kind of precaution should be taken in Insulinoma?

    Doctors don?t know why insulinomas form, so there?s no known way to prevent them. However, you can reduce your risk of developing hypoglycemia by exercising regularly and maintaining a healthy diet. This diet should largely consist of fruits, vegetables, and lean protein. You can also keep your pancreas healthy by eating less red meat and quitting smoking if you smoke.

    Treatment for the Insulinoma

    Diagnosis:

    In order to diagnose an insulinoma, patients suspected of the disease are usually admitted to hospital to undergo a supervised 72-hour fast. During this time, patients are allowed to drink water, but not to eat food. Regular finger-prick tests for blood sugar levels are done. If the blood sugar drops below a certain level, a blood sample to test for glucose, insulin and another substance, C-peptide, is taken. A blood or urine test is also taken to test for any medications that might cause the blood sugar levels to drop. If the blood test confirms that the blood glucose is below the criteria level, the fast is stopped and the patient is allowed to eat.

    Computerised tomography (CT) or magnetic resonance imaging (MRI) scans are used to look for insulinomas in the pancreas and liver and to locate their exact position.

    Insulinomas may not always be straightforward to find on a CT or MRI scan and so one or more of a variety of other localisation techniques may also be used:

    • specialised nuclear medicine scans such as octreotide or positron emission tomography (PET) scans may be used to identify insulinomas and to look for any evidence of spread of the tumours an octreotide scan. In an octreotide scan, the doctor will inject a substance known as octreotide (which has been made mildly radioactive) into your body. The octreotide sticks to the insulinoma cells so the doctor can then use a scanner to identify where the octreotide is and therefore where the insulinoma cells are. This will help identify whether the insulinoma has spread or whether it is confined to one place

    • special ultrasound machines may be used, either attached to a telescope passed, under gentle sedation, through the mouth (endoscopic ultrasound) or during the time of surgery (intra-operative ultrasound)

    • a procedure known as a calcium stimulation test can be used to confirm that the insulinoma is in the pancreas and actively secreting insulin. This is done in specialist hospitals. It involves placing thin plastic tubes (catheters), under local anaesthetic, into the groin area. Using small injections of special dye that shows up under an X-ray machine, these catheters are threaded into the blood vessels that supply the pancreas with blood. Then a small amount of calcium solution, which is harmless to patients, is injected into the blood vessels, and blood tests are taken to measure the levels of insulin secreted by the pancreas. This test usually takes about 1 hour to perform.

    If multiple endocrine neoplasia type 1 is suspected, a blood test to look for defects in the gene responsible for this disease can be carried out. Genetic specialists will talk through the implications of genetic testing, which is usually performed in outpatient clinics.

    Treatment:

    The best treatment for an insulinoma is surgical removal of the tumor. A small part of the pancreas may also be removed if there?s more than one tumor. This typically cures the condition.

    There are various types of surgery that can be performed to remove the insulinoma. The location and number of tumors determine which surgery will be used.

    Laparoscopic surgery is the preferred option if there?s only one small pancreatic tumor. This is a low-risk, minimally invasive procedure. During laparoscopic surgery, your surgeon makes several small incisions in your abdomen and inserts a laparoscope through the incisions. A laparoscope is a long, thin tube with a high-intensity light and a high-resolution camera at the front. The camera will display the images on a screen, allowing the surgeon to see inside your abdomen and guide the instruments. When the insulinoma is found, it will be removed.

    Part of the pancreas may need to be removed if there are multiple insulinomas. Sometimes, part of the stomach or liver may be removed as well.

    In rare cases, removing the insulinoma won?t cure the condition. This is usually true when the tumors are cancerous. Treatments for cancerous insulinomas include:

    • radiofrequency ablation, which uses radio waves to kill cancerous cells in the body
    • cryotherapy, which involves the use of extreme cold to destroy cancerous cells
    • chemotherapy, which is an aggressive form of chemical drug therapy that helps destroy cancerous cells

    Possible complication with Insulinoma

    After surgery to remove an insulinoma, some people develop a pancreatic fistula. This causes pancreatic fluid to leak. You may be given medicine and extra fluids to help your fistula heal. Most close without the need for more surgery.

    References:

    1 https://www.hopkinsmedicine.org/health/conditions-and-diseases/insulinoma 2 https://www.healthline.com/health/insulinoma#treatment 3 https://www.webmd.com/diabetes/what-is-insulinoma#2-6 4 https://www.yourhormones.info/endocrine-conditions/insulinoma/ 5 https://emedicine.medscape.com/article/283039-overview 6 https://emedicine.medscape.com/article/283039-treatment 7 https://medlineplus.gov/ency/article/000387.htm 8 https://www.merckmanuals.com/professional/gastrointestinal-disorders/tumors-of-the-gastrointestinal-tract/insulinoma

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