PMID- 37925662
OWN - NLM
STAT- MEDLINE
DCOM- 20240318
LR  - 20240318
IS  - 1945-7197 (Electronic)
IS  - 0021-972X (Print)
IS  - 0021-972X (Linking)
VI  - 109
IP  - 4
DP  - 2024 Mar 15
TI  - Approach to the Patient: Insulinoma.
PG  - 1109-1118
LID - 10.1210/clinem/dgad641 [doi]
AB  - Insulinomas are hormone-producing pancreatic neuroendocrine neoplasms with an 
      estimated incidence of 1 to 4 cases per million per year. Extrapancreatic 
      insulinomas are extremely rare. Most insulinomas present with the Whipple triad: 
      (1) symptoms, signs, or both consistent with hypoglycemia; (2) a low plasma 
      glucose measured at the time of the symptoms and signs; and (3) relief of 
      symptoms and signs when the glucose is raised to normal. Nonmetastatic 
      insulinomas are nowadays referred to as "indolent" and metastatic insulinomas as 
      "aggressive." The 5-year survival of patients with an indolent insulinoma has 
      been reported to be 94% to 100%; for patients with an aggressive insulinoma, this 
      amounts to 24% to 67%. Five percent to 10% of insulinomas are associated with the 
      multiple endocrine neoplasia type 1 syndrome. Localization of the insulinoma and 
      exclusion or confirmation of metastatic disease by computed tomography is 
      followed by endoscopic ultrasound or magnetic resonance imaging for indolent, 
      localized insulinomas. Glucagon-like peptide 1 receptor positron emission 
      tomography/computed tomography or positron emission tomography/magnetic resonance 
      imaging is a highly sensitive localization technique for seemingly occult, 
      indolent, localized insulinomas. Supportive measures and somatostatin receptor 
      ligands can be used for to control hypoglycemia. For single solitary insulinomas, 
      curative surgical excision remains the treatment of choice. In aggressive 
      malignant cases, debulking procedures, somatostatin receptor ligands, peptide 
      receptor radionuclide therapy, everolimus, sunitinib, and cytotoxic chemotherapy 
      can be valuable options.
CI  - (c) The Author(s) 2023. Published by Oxford University Press on behalf of the 
      Endocrine Society.
FAU - Hofland, Johannes
AU  - Hofland J
AUID- ORCID: 0000-0003-0679-6209
AD  - ENETS Center of Excellence, Department of Internal Medicine, Section of 
      Endocrinology, Erasmus MC and Erasmus MC Cancer Institute, 3015 GD Rotterdam, The 
      Netherlands.
FAU - Refardt, Julie C
AU  - Refardt JC
AUID- ORCID: 0000-0002-3040-4685
AD  - ENETS Center of Excellence, Department of Internal Medicine, Section of 
      Endocrinology, Erasmus MC and Erasmus MC Cancer Institute, 3015 GD Rotterdam, The 
      Netherlands.
AD  - ENETS Center of Excellence, Division of Endocrinology, Diabetology and 
      Metabolism, University Hospital Basel, CH-4031 Basel, Switzerland.
FAU - Feelders, Richard A
AU  - Feelders RA
AUID- ORCID: 0000-0003-2319-391X
AD  - ENETS Center of Excellence, Department of Internal Medicine, Section of 
      Endocrinology, Erasmus MC and Erasmus MC Cancer Institute, 3015 GD Rotterdam, The 
      Netherlands.
FAU - Christ, Emanuel
AU  - Christ E
AUID- ORCID: 0000-0002-5604-4606
AD  - ENETS Center of Excellence, Division of Endocrinology, Diabetology and 
      Metabolism, University Hospital Basel, CH-4031 Basel, Switzerland.
FAU - de Herder, Wouter W
AU  - de Herder WW
AUID- ORCID: 0000-0003-1463-5165
AD  - ENETS Center of Excellence, Department of Internal Medicine, Section of 
      Endocrinology, Erasmus MC and Erasmus MC Cancer Institute, 3015 GD Rotterdam, The 
      Netherlands.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Clin Endocrinol Metab
JT  - The Journal of clinical endocrinology and metabolism
JID - 0375362
RN  - 0 (Receptors, Somatostatin)
SB  - IM
MH  - Humans
MH  - *Insulinoma/diagnosis/therapy/complications
MH  - Receptors, Somatostatin/therapeutic use
MH  - *Pancreatic Neoplasms/therapy/drug therapy
MH  - *Hypoglycemia/diagnosis/etiology/therapy
MH  - *Neuroendocrine Tumors/complications
PMC - PMC10940262
OTO - NOTNLM
OT  - hypoglycemia
OT  - insulin
OT  - insulinoma
OT  - pathology
OT  - therapy
EDAT- 2023/11/05 18:42
MHDA- 2024/03/18 06:42
PMCR- 2023/10/31
CRDT- 2023/11/05 15:04
PHST- 2023/08/22 00:00 [received]
PHST- 2024/03/18 06:42 [medline]
PHST- 2023/11/05 18:42 [pubmed]
PHST- 2023/11/05 15:04 [entrez]
PHST- 2023/10/31 00:00 [pmc-release]
AID - 7334393 [pii]
AID - dgad641 [pii]
AID - 10.1210/clinem/dgad641 [doi]
PST - ppublish
SO  - J Clin Endocrinol Metab. 2024 Mar 15;109(4):1109-1118. doi: 
      10.1210/clinem/dgad641.