Endocrine Abstracts

Introduction: Inslinomas are the most common cause of hypoglycemia resulting from endogenous hyperinsulinism. Although rare, they have the potential to produce metabolic derangements, necessitating early diagnosis. The aim of our study was to determine the clinical manifestations, diagnostic methods, treatments used and results of patients with insulinoma.

Patients and methods: It’s a retrospective study including 9 patients with insulinoma, diagnosed between 1991 and 2016, at the department of endocrinology at Hedi Chaker-hospital Sfax-Tunisia.

Results: No sex predilection was apparent: 5 males and 4 females, with a mean age of 44.2 years (range, 18–68). Average duration of symptoms was 18, 25 months (6 months–6years). Frequency of hypoglycemic episodes ranged from daily to 7 times a week. Approximately 88.5% of patients consulted for neuroglycopenia symptoms: loss of consciousness (6 cases), convulsions (4 cases), abnormal behavior (2 cases) and headache (4 cases). Weakness and weigh gain was observed in 8 patients each. 66.5% of patients experienced late postprandial hypoglycemia. Therefore, fasting hypoglycemia were observed in 88.8%. The mean fasting blood sugar level was 2, 91 mmol/l. Six (66.5%) patients had spontaneous hypoglycemia during hospitalization and 44.5% required a prolonged fast to induce hypoglycemia, with a mean duration of fast of 22.75 hours. The mean blood glucose level at the time of hypoglycemia was 0.39 g/l and concomitant mean plasma insulin was 20.2 μUI/ml (range 10.6–45.6). Concomitant pro-insulin level was estimated in 2 patients with a mean level of 45.13 pmol/l. Multiple endocrine neoplasia type 1(MEN1) was objected in one patient. Preoperative localization identification was accomplished in eight cases, using a combination of radiological techniques including: transabdominal ultrasonography (9 cases), endoscopic ultrasound (6 cases) and MRI (2 cases). The tumor was located in the body and tail regions in 4 patients each and in the head region in only one case. Multiple adenomas were observed in only one case. 8 patients underwent surgery. The tumor size ranged from 9 mm to 40 mm. Death occurred in 2 cases. Five subjects had no recurrence of hypoglycemia and are considered cured on follow-up. In addition, one patient developed transient post operative diabetes and glucose intolerance was observed in only one case.

Conclusion: Insulinoma may occur at any age and the diagnosis must be established as soon as the first manifestations occur to preserve prognosis.