7/14/16 AM Report: Insulinoma

Whipple’s Triad:

  1. Symptoms consistent with hypoglycemia
  2. Documented low plasma glucose when symptoms present
  3. Relief of symptoms following resolution of hypoglycemia

Physiological response to hypoglycemia:

hypo1a

Endogenous Insulin Synthesis:

biosynthesis-of-insulin

  • Endogenous insulin is formed as two insulin chains (A & B) linked by C-peptide.  Measurement of C-peptide can help distinguish from endogenous versus exogenous insulin.

Causes of Hypoglycemia:

  1. Drugs (insulin, sulfonylureas, alcohol)
  2. Critical illness (hepatic failure, sepsis, etc.)
  3. Hormone deficiency (cortisol, glucagon, etc.)
  4. Non-islet cell tumor ~ increased production of IL-GF2 resulting increased glucose utilization
  5. Endogenous insulin
    • Insulinoma
    • Non-insulinoma Pancreatogenous Hypoglycemic Syndrome (NIPHS)
    • Post-gastric bypass hypoglycemia
    • Antibody to insulin / Antibody to insulin receptor

Interpretation of 72 hour glucose fast data:

Capture

*Remember the only way to distinguish between insulinoma, NIPHS, PGBH and a sulfonylurea ingestion is with a urine sulfonylurea toxicity screen!

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