The insulinoma as a diagnostically and therapeutically challenging neoplasm
DOI:
https://doi.org/10.12775/JEHS.2021.11.09.067Keywords
Neuroendocrine pancreatic tumor, diagnosis, molecular imaging, treatment, robotic surgeryAbstract
Introduction and purpose
An insulinoma is the most common neuroendocrine tumor of a pancreas. This tumor produces insulin, which in excess causes hypoglycemic attacks, provoked by hunger or physical effort. Delays in diagnostic processes of the insulinoma are associated with the misattribution of symptoms to cardiac, psychiatric or neurological disorders. Thus, the suitable diagnostic procedures play a significant role as they ensure quick introduction of treatment. The purpose of this work is to evaluate advances in demanding diagnostically and therapeutically insulinoma.
A brief description of the state of knowledge
The used method was a literature review. The basic and the most common method of treating the insulinoma is a surgery. Due to this, finding precise location of the tumor preoperatively is crucial. In the diagnostics of the insulinoma both basic CT and MRI contrast enhanced and an endoscopic ultrasound, a selective arterial calcium stimulation test and the latest molecular imaging are used. In treatment process not only traditional surgical excisions were performed, but also laparoscopic and robotic surgeries turned out to be success.
Conclusions
Summing up, the insulinoma is a neoplasm with a wide range of therapeutic and diagnostic solutions, thanks to the progress that has been made in recent years. Although there are many difficulties on a diagnostic path of the insulinoma, new solutions and appropriate aproach make this process easier. Nevertheless, doctor’s diagnostic vigilance is essential, because consideration in the differential diagnosis the insulinoma is an essential step and without this step any further actions can be taken.
References
Okabayashi T, Shima Y, Sumiyoshi T, Kozuki A, Ito S, Ogawa Y, et al. Diagnosis and management of insulinoma. World J Gastroenterol 2013;19:829–37. https://doi.org/10.3748/WJG.V19.I6.829.
Ito T, Lee L, Jensen R. Treatment of symptomatic neuroendocrine tumor syndromes: recent advances and controversies. Expert Opin Pharmacother 2016;17:2191–205. https://doi.org/10.1080/14656566.2016.1236916.
Matej A, Bujwid H, Wroński J. Glycemic control in patients with insulinoma. Hormones (Athens) 2016;15:489–99. https://doi.org/10.14310/HORM.2002.1706.
Shin J, Gorden P, Libutti S. Insulinoma: pathophysiology, localization and management. Future Oncol 2010;6:229–37. https://doi.org/10.2217/FON.09.165.
Mathur A, Gorden P, Libutti SK. Insulinoma. Surg Clin North Am 2009;89:1105. https://doi.org/10.1016/J.SUC.2009.06.009.
Pobłocki J, Jasińska A, Syrenicz A, Andrysiak-Mamos E, Szczuko M. The Neuroendocrine Neoplasms of the Digestive Tract: Diagnosis, Treatment and Nutrition. Nutrients 2020;12:1437. https://doi.org/10.3390/NU12051437.
Wang H, Ba Y, Xing Q, Cai RC. Diagnostic value of ASVS for insulinoma localization: A systematic review and meta-analysis. PLoS One 2019;14. https://doi.org/10.1371/JOURNAL.PONE.0224928.
Christ E, Antwi K, Fani M, Wild D. Innovative imaging of insulinoma: the end of sampling? A review. Endocr Relat Cancer 2020;27:R79–92. https://doi.org/10.1530/ERC-19-0476.
Antwi K, Fani M, Nicolas G, Rottenburger C, Heye T, Reubi JC, et al. Localization of Hidden Insulinomas with 68Ga-DOTA-Exendin-4 PET/CT: A Pilot Study. J Nucl Med 2015;56:1075–8. https://doi.org/10.2967/JNUMED.115.157768.
Antwi K, Fani M, Heye T, Nicolas G, Rottenburger C, Kaul F, et al. Comparison of glucagon-like peptide-1 receptor (GLP-1R) PET/CT, SPECT/CT and 3T MRI for the localisation of occult insulinomas: evaluation of diagnostic accuracy in a prospective crossover imaging study. Eur J Nucl Med Mol Imaging 2018;45:2318–27. https://doi.org/10.1007/S00259-018-4101-5.
Luo Y, Pan Q, Yao S,Yu M, Wu W, Xue H, et al. Glucagon-Like Peptide-1 Receptor PET/CT with 68Ga-NOTA-Exendin-4 for Detecting Localized Insulinoma: A Prospective Cohort Study. J Nucl Med 2016;57:715–20. https://doi.org/10.2967/JNUMED.115.167445.
Mahalakshmi B, Baskaran R, Shanmugavadivu M, Nguyen NT, Velmurugan BK. Insulinoma-associated protein 1 (INSM1): a potential biomarker and therapeutic target for neuroendocrine tumors. Cell Oncol (Dordr) 2020;43:367–76. https://doi.org/10.1007/S13402-020-00505-9.
Sua AP, Ke NW, Zhang Y, Liu XB, Hu WM, Tian BL, et al. Is laparoscopic approach for pancreatic insulinomas safe? Results of a systematic review and meta-analysis. J Surg Res 2014;186:126–34. https://doi.org/10.1016/J.JSS.2013.07.051.
Kang I, Hwang HK, Lee WJ, Kang CM. First experience of pancreaticoduodenectomy using Revo-i in a patient with insulinoma. Ann Hepato-Biliary-Pancreatic Surg 2020;24:104–8. https://doi.org/10.14701/AHBPS.2020.24.1.104.
Robben JH, van den Brom W, Mol JA, van Haeften TW, Rijnberk A. Effect of octreotide on plasma concentrations of glucose, insulin, glucagon, growth hormone, and cortisol in healthy dogs and dogs with insulinoma. Res Vet Sci 2006;80:25–32. https://doi.org/10.1016/J.RVSC.2005.03.005.
Warren AM, Topliss DJ, Hamblin PS. Successful medical management of insulinoma with diazoxide for 27 years. Endocrinol Diabetes Metab Case Reports 2020;2020:1–5. https://doi.org/10.1530/EDM-20-0132.
Nakumara A, Mitsuhashi T, Takano Y, Miyoshi H, Kameda H, Nomoto H, et al. Usefulness of the octreotide test in Japanese patients for predicting the presence/absence of somatostatin receptor 2 expression in insulinomas. Endocr J 2016;63:135–42. https://doi.org/10.1507/ENDOCRJ.EJ15-0371.
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