Pancreatic insulinoma in humans: symptoms and diagnosis. Insulinoma: laboratory diagnosis

Insulinoma is one of the types of tumors that secretes a significant amount of insulin, which, in turn, leads to frequent attacks of hypoglycemia (low blood glucose levels) in patients. The most common is pancreatic insulinoma. Very rarely, insulinomas can occur in the small or large intestine, or in the liver.

Insulinoma mainly affects people of the most able-bodied age from 25 to 55 years. But in children and adolescents, this tumor is practically not found.

In 90% of cases, pancreatic insulinoma is a benign tumor. In some patients, the appearance of insulinoma is one of the signs of endocrine multiple adenomatosis.

Insulinoma: symptoms

The main manifestation of insulinoma is attacks of hypoglycemia due to high content in the blood of patients with insulin. Patients experience sudden attacks of severe general weakness, fatigue, accompanied by tachycardia (rapid heartbeat), sweating, fear, anxiety. At the same time, patients experience severe hunger. After eating, all these symptoms of insulinoma disappear almost immediately.

The most dangerous course of insulinoma is in patients who do not feel the state of hypoglycemia. In this regard, they cannot take food in a timely manner and stabilize their condition. With a further decrease in the concentration of glucose in the blood, their behavior becomes inadequate. Patients have hallucinations, accompanied by quite bright and figurative pictures. There is salivation, profuse sweating, double vision. The patient may take violent actions against those around him in order to take food away from them.

A further drop in the level of glucose in the blood serum leads to an increase in muscle tone, up to an extended epileptic seizure. Tachycardia increases, blood pressure rises, and the pupils dilate.

If the patient is not provided with medical care, then hypoglycemic coma occurs. Consciousness is lost, pupils dilate, muscle tone decreases, sweating stops, heartbeat and breathing rhythm, blood pressure drops. Against the background of hypoglycemic coma, the patient may develop cerebral edema.

In addition to bouts of hypoglycemia, another symptom of insulinoma is an increase in body weight up to the development of obesity.

It is very important that not only patients, but also their closest relatives, know the symptoms of insulinoma well so that they can interrupt an attack of hypoglycemia in a timely manner, preventing the development of psychosis or coma.

Glucose deficiency adversely affects the neurons of the brain. Therefore, frequent and prolonged coma with insulinoma can cause the patient to develop dyscirculatory encephalopathy, parkinsonism, and convulsive syndrome.

Diagnosis of insulinoma

Diagnosis of insulinoma presents sometimes significant difficulties. If insulinoma is suspected, a person is hospitalized and, under close medical supervision, fasting is prescribed for him for 24 to 72 hours. When symptoms of insulinoma appear in a patient, blood is taken to determine the content of glucose and insulin in it. Indicates the presence of insulinoma low level glucose and high insulin levels.

At the next diagnostic stage, the exact location of the insulinoma is identified. To do this, perform magnetic resonance or computed tomography, ultrasound procedure. In some cases, it may be necessary to diagnostic laparoscopy or laparotomy.

Insulinoma: treatment

The main treatment for insulinoma is surgery. In its course, the tumor is removed within healthy tissues.

In cases where surgical treatment of insulinoma for some reason cannot be performed, conservative therapy is prescribed. It consists in rational nutrition patients, timely relief of attacks of hypoglycemia, drug therapy aimed at improving metabolic processes in the brain.

To stop an attack of hypoglycemia, it is easiest to offer the patient a glass of sweet hot tea or candy. If consciousness is disturbed, a glucose solution should be administered intravenously. With the development of an attack of psychosis or hypoglycemic coma, an ambulance should be called immediately.

Video from YouTube on the topic of the article:

is a hormonally active type of tumor that affects the pancreatic islets (Islets of Langerhans). It affects beta cells, resulting in uncontrolled production and entry into the blood of insulin. Such neoplasms can be benign (in 70% of cases) or be adenocarcinomas. The latter have a diameter of 6 cm or more.

There are other types of pancreatic tumors (insulomas) that develop from alpha, delta, and PP cells. In this case, other types are produced: pancreatic polypeptide, gastrin, serotonin, somatostatin or adrenocorticotropic hormone. Insulinoma occurs usually in patients aged 35 to 60 years, and is extremely rare in patients. Men get sick 2 times less often than women.

Causes

insulinoma is not hereditary disease, is quite rare. Its etiology remains unclear. It has been proven that often pancreatic tumors are provoked by low blood glucose, which is caused by a violation of insulin production. Hypoglycemia can occur in the following conditions:

• lack of growth hormone, which is caused by a decrease in the functioning of the anterior pituitary gland (this leads to reduced insulin activity);
• insufficiency of the adrenal cortex (acute or chronic), which leads to a decrease in the level of glucocorticoids and a decrease in the amount of sugar in the blood;
• exhaustion of the body caused by prolonged illness or starvation;
• myxedema due to low content thyroid substances that raise glucose levels;
• if the body is poorly absorbed carbohydrates;
• liver diseases caused by toxic damage;
• nervous exhaustion (due to loss of appetite);
• tumors in abdominal cavity;
• enterocolitis.

Pancreatic insuloma most often affects the tail or body of the organ. It is extremely rarely located outside the gland, based on the ectopic (additional) tissue of the organ. It looks like a dense formation, its diameter varies from 0.5 to 8 cm. The color of the tumor is white, gray or brown.

Single insulinomas are more often diagnosed, only in rare cases are multiple formations present. The tumor is characterized by slow development, metastases occur occasionally and only in malignant forms.

Development and signs of the disease

With insulinoma of the pancreas, the symptoms are due to bouts of hypoglycemia. This is due to increased production of insulin by the tumor, regardless of the level of glucose in the blood. At healthy people with a drop in glucose levels (for example, at), a significant decrease in the amount of insulin is observed. With insulinoma, this mechanism does not work, as it is disturbed by tumor insulin. This creates the conditions for the occurrence of a hypoglycemic attack.

Hypoglycemia is a complex of symptoms resulting from an imbalance in the structure of blood glucose regulation. It develops when the sugar level drops to a value of 2.5 mmol / l.

Clinically, hypoglycemia is manifested by the development of neuropsychiatric disorders and an increase in the amount of a number of hormones: norepinephrine, cortisol, glucagon. Elevated norepinephrine causes bouts of sweating, tremors, and angina pectoris. Seizures are spontaneous and become more severe over time.

All patients with insulinoma have the Whipple triad, which has the following features:

• manifestation neuropsychiatric disorders during fasting;
• drop in blood glucose below 2.7 mmol / l;
• the ability to eliminate a hypoglycemic attack by intravenous or oral administration glucose.

Most of all, with this syndrome, the brain suffers, since glucose is the main source of nutrition for it. In chronic hypoglycemia, dystrophic changes in the central nervous system.

Symptoms of insulinoma

With the development of hypoglycemia, the patient has a feeling of sudden weakness, fatigue, tachycardia, sweating, tremor, and a feeling of hunger. Eating allows you to almost immediately eliminate this manifestation. If the patient could not satisfy his hunger in time or did not feel the first signs of hypoglycemia in time, there is a further decrease in the concentration of sugar in the blood. This is accompanied by an increase in symptoms of a neuropsychic nature and is manifested by inappropriate behavior. Symptoms such as:

• erratic and fussy movements;
• aggression towards others;
• verbal excitement, often meaningless phrases or sounds;
• salivation;
• bouts of unreasonable fun;
• confusion;
• hallucinations;
• a good mood;
• sketchy thinking;
• lack of adequacy in assessing one's own condition.

If such a patient is not given timely medical care, then a further decrease in blood sugar will lead to a state of epileptic seizure, and then a hypoglycemic coma will occur. In this condition, there is a complete loss of consciousness, slowing of the heartbeat and respiration, blood pressure drops to critical values. As a result, cerebral edema may develop.

Signs of insulinoma in the latent phase

In the periods between attacks, insulinoma also manifests itself in the form various symptoms and disorders. It is important to know them so that the doctor can prescribe the optimal therapy. In the latent phase, patients may show the following symptoms:

• muscle weakness or other disturbances in muscle movement (ataxia);
• headache;
• memory impairment and mental decline;
• visual impairment;
• mood swings;
• violations of flexion-extensor reflexes of the limbs;
• nystagmus;
• increased appetite and the appearance of excess weight;
• violations in the sexual sphere.

Diagnosis consists of a 48- or 72-hour fast test with measurements of glucose and insulin levels, followed by endoscopic ultrasound. Treatment - surgical (if possible).

Among all cases of insulinoma, 80% have a single node and, if detected, a cure can be achieved. 10% insulin malignant. Insulinomas develop at a rate of 1/250,000. Insulinomas in type I MEN are more likely to be multiple.

Hidden administration of exogenous insulin can provoke episodes of hypoglycemia, resembling the picture of insulinoma.

Prevalence of pancreatic insulinoma

The overall incidence of insulin is low - 1-2 cases per 1 million population per year, but they account for almost 80% of all known hormonally active pancreatic neoplasms. They can be either solitary (usually sporadic forms) or multiple (more often hereditary), which creates diagnostic difficulties before surgery. Insulinomas are localized in the pancreas, but in 1-2% of cases they can develop from ectopic tissue and have extrapancreagic localization.

Insulinoma is a frequent component of the MEN type I syndrome, which also includes hormonally active tumors of the parathyroid glands, adenohypophysis, and tumors of the adrenal cortex (often hormonally inactive).

In most patients, insulinoma is benign, in 10-20% it has signs of malignant growth. Insulinomas larger than 2-3 cm in diameter are often malignant.

Classification of pancreatic insulinoma

In ICD-10 insulinoma corresponds to the following headings.

• C25.4 malignant neoplasm pancreatic islet cells.
• D13.7 benign neoplasm pancreatic islet cells.

Insulinoma is the most common cause syndrome of organic hyperinsulinism, which is characterized by severe HS, mainly at night and on an empty stomach, i.e. after a long enough fast. Hyperinsulinism is an endogenous hyperproduction of insulin, which leads to an increase in its concentration in the blood (hyperinsulinemia) with a high probability of developing a symptom complex of hypoglycemia. Organic hyperinsulinism is formed on the basis of morphological structures that produce in in large numbers insulin. In addition to insulinoma, more rare causes of organic hyperinsulinism are adenomatosis and islet cell hyperplasia - nesidioblastosis.

Based on practical purposes, a functional form of hyperinsulinism is distinguished, in most cases characterized by a more benign course and prognosis (Table 3.21).

Causes and pathogenesis of pancreatic insulinoma

Under conditions of hyperinsulinemia, the formation and fixation of glycogen in the liver and muscles increases. Insufficient supply of the brain with the main energy substrate is initially accompanied by functional neurological disorders, and then - irreversible morphological changes CNS with the development of cerebroasthenia and decreased intelligence.

In the absence of timely food intake, attacks of hypoglycemia develop varying degrees severity, manifested by adrenergic and cholinergic symptoms and symptoms of neuroglycopenia. The result of a long-term severe energy deficiency of the cells of the cerebral cortex is their edema and the development of hypoglycemic coma.

The main causes of functional hyperinsulinism in adults

Symptoms and signs of pancreatic insulinoma

Hypoglycemia in insulinoma develops on an empty stomach. Symptoms may be blurred and sometimes mimic various psychiatric and neurological disorders. Often there are symptoms of increased sympathetic activity (general weakness, trembling, palpitations, sweating, hunger, irritability).

Absence specific symptoms is one of the main reasons late diagnosis insulinomas. In this case, the anamnesis of the disease can be calculated for years. Of the variety of clinical manifestations, psycho-neurological symptoms stand out especially - episodes of disorientation, speech and motor disorders, strange behavior, decreased mental capacity for work and memory, loss of professional skills, amnesia, etc. The vast majority of other symptoms (including cardiovascular and gastrointestinal) are a manifestation of acutely developed neuroglycopenia and autonomic response.

Patients often wake up with difficulty long time are disoriented, answer the simplest questions in monosyllables, or simply do not come into contact with others. Attention is drawn to the confusion or slurring of speech, the same type of repetitive words and phrases, unnecessary monotonous movements. The patient may be disturbed by headache and dizziness, paresthesia of the lips, diplopia, sweating, a feeling of internal trembling or chills. Episodes of psychomotor agitation and epileptiform seizures are possible. There may be symptoms such as a feeling of hunger and emptiness in the stomach associated with the reaction of the gastrointestinal system.

As you deepen pathological process stupor, hand tremors, muscle twitches, convulsions appear, coma may develop. Due to retrograde amnesia, patients, as a rule, cannot tell about the nature of the attack.

Out of necessity frequent use food patients are often obese.

With an increase in the duration of the disease, the condition of patients in the interictal period changes significantly due to violations of the higher cortical functions of the central nervous system: changes in the intellectual and behavioral spheres develop, memory worsens, mental capacity for work decreases, professional skills are gradually lost, negativism and aggression may develop, which is associated with characterological features person.

Diagnosis of pancreatic insulinoma

• content of insulin.
• In some cases - the content of C-peptide and proinsulin.
• Endoscopic ultrasound.

With the development of symptoms, it is necessary to evaluate the level of glucose in the blood serum. In the presence of hypoglycemia, it is necessary to evaluate the level of insulin in a simultaneously taken blood sample. Hyperinsulinemia > 6 μU/ml indicates the presence of insulin-mediated hypoglycemia.

Insulin is secreted in the form of proinsulin, consisting of an α-chain and a β-chain connected by a C-peptide. Because commercially produced insulin contains only β-chain, clandestine administration of insulin preparations can be detected by measuring the level of C-peptide and proinsulin. With the secret use of insulin preparations, the level of these indicators is normal or reduced.

Since many patients have no symptoms at the time of examination (and therefore no hypoglycemia), hospitalization is indicated for a 48-72 hour fasting test to confirm the diagnosis. Almost all patients with insulinoma (98%) within a 48-hour fasting develop clinical manifestations; in 70-80% - within the next 24 hours. The role of hypoglycemia in the onset of symptoms is confirmed by the Whipple triad:

1. symptoms appear on an empty stomach;
2. symptoms appear with hypoglycemia;
3. eating carbohydrates leads to a reduction in symptoms.

If components of the Whipple triad are not observed after a fasting period, and plasma glucose after an overnight fasting period is > 50 mg/dL, a C-peptide suppression test may be performed. During insulin infusion in patients with insulinoma, there is no decrease in the content of C-peptide to a normal level.

Endoscopic ultrasonography has a sensitivity of >90% in detecting a tumor focus. For this purpose, PET is also performed. CT has no proven informative value; in carrying out arteriography or selective catheterization of the portal and splenic veins, as a rule, there is no need.

Despite the bright clinical picture, with organic hyperinsulinism, such diagnoses as violation of cerebral circulation, diencephalic syndrome, epilepsy, alcohol intoxication.

With a fasting blood glucose concentration of more than 3.8 mmol / l and the absence of convincing data for HC in the anamnesis, the diagnosis of insulinoma can be excluded. With fasting glycemia of 2.8-3.8 mmol / l, as well as more than 3.8 mmol / l in combination with a history of hypoglycemia, a fasting test is performed, which is a method of provoking the Whipple triad. The sample is considered positive when there are laboratory changes and clinical symptoms hypoglycemia, which is stopped by intravenous administration of a glucose solution. In most patients, the Whipple triad is provoked within a few hours from the start of the test. In organic hyperinsulinism, the levels of insulin and C-peptide are stably elevated and do not decrease during fasting, in contrast to healthy individuals and patients with functional hyperinsulinism.

At positive sample with fasting, topical tumor diagnosis is performed using ultrasound (including endoscopic ultrasound of the gastrointestinal tract with visualization of the pancreas), MRI, CT, selective angiography, percutaneous transhepatic catheterization of the portal vein branches, pancreaticoscopy with biopsy.

Up to 90% of insulins have somatostatin receptors. Somatostatin receptor scintigraphy using the radioactive synthetic drug somatostatin - pentetreotide allows for topical diagnosis of tumors and their metastases, as well as postoperative control over the radicalness of surgical treatment.

Important diagnostic method is an intraoperative revision of the pancreas and liver, which allows to detect a neoplasm and metastases that could not be identified before the operation.

Differential Diagnosis

If, after laboratory confirmation of organic hyperinsulinism, it was not possible to visualize insulinoma, percutaneous or laparoscopic diagnostic needle biopsy PZh. Subsequent morphological study allows you to establish other causes of organic hyperinsulinism - nesidioblastosis, pancreatic microadenomatosis. During differential diagnosis a number of diseases and conditions accompanied by the development of hypoglycemia should be excluded: fasting; severe violations of the liver, kidneys, sepsis (due to a decrease in gluconeogenesis or a decrease in the metabolism of endogenous insulin); large mesenchymal tumors utilizing glucose; adrenal insufficiency and severe hypothyroidism; introduction excess insulin in the treatment of diabetes, taking large amounts of alcohol and high doses of certain medicines; congenital disorders of glucose metabolism (defects in gluconeogenesis enzymes); formation of antibodies to insulin.

Treatment of pancreatic insulinoma

• Education resection.
• Diazoxide and sometimes octreotide to correct hypoglycemia.

Complete cure rate with surgical treatment reaches 90%. Solitary insulinoma small size on or just below the surface of the pancreas can usually be removed by enucleation. With a single large or deep adenoma, with multiple formations of the body and / or tail, or if insulinoma cannot be detected (this is a rare case), a distal subtotal pancreatectomy is performed. In less than 1% of cases, insulinoma has an ectopic location in the peripancreatic tissues - in the wall duodenum, periduodenal region and can only be detected with a thorough surgical revision. Pancreatoduodenectomy (Whipple operation) is performed for resectable malignant insulinomas of the proximal pancreas. Total pancreatectomy is performed in cases where a previous subtotal pancreatectomy has failed.

With long-term hypoglycemia, diazoxide can be given in combination with a natriuretic. The somatostatin analogue octreotide has a variable effect and may be considered in patients with long-term hypoglycemia not responding to diazoxide treatment. Against the background of the use of octreotide, it may be necessary to additionally take pancreatin preparations, because. pancreatic secretion is suppressed. Other drugs with moderate and variable inhibitory effects on insulin secretion include verapamil, diltiazem, and phenytoin.

If symptoms cannot be controlled, trial chemotherapy can be given, but its effectiveness is limited. When prescribing streptozocin, the probability of achieving an effect is 30-40%, in combination with 5-fluorouracil - 60% (remission duration up to 2 years). Other treatments are doxorubicin, chlorozotocin, interferon.

The most radical and best method treatment - surgical path enucleation of the tumor or partial resection of the pancreas. In malignant insulinoma, pancreatic resection is combined with lymphadenectomy and removal of visible regional metastases (often in the liver).

If it is impossible to remove the tumor and if it is ineffective surgical treatment held symptomatic therapy, aimed at prevention (frequent fractional intake of carbohydrate foods, diazoxide) and relief of HS ( intravenous administration glucose or glucagon).

If during the examination were obtained positive results scanning with octreotide, then synthetic analogues of somatostatin are prescribed - octreotide and its forms of prolonged action [octreotide (octreotide-depot), lanreotide], which have antiproliferative activity and inhibit not only the secretion of growth hormone, but also insulin, serotonin, gastrin, glucagon, secretin , motilin, vasointestinal polypeptide, pancreatic polypeptide.

When confirming the malignant nature of insulinoma, chemotherapy with streptozotocin is indicated, the action of which is the selective destruction of P-cells of the pancreas.

Dispensary observation

Patients are monitored by an endocrinologist and a surgeon, if necessary, together with an oncologist. After surgical treatment, an annual hormonal examination, ultrasound of the liver, if indicated, MRI and MRI of the abdominal organs are performed to exclude recurrence and metastasis.

Prevention of pancreatic insulinoma

It is necessary to prevent HS, which is carried out by individually more frequent use carbohydrate food.

Prognosis of pancreatic insulinoma

With timely radical treatment benign insulinoma prognosis is favorable.

Most pancreatic diseases directly affect carbohydrate metabolism. Insulinoma increases the production of insulin in the body. When carbohydrates in habitual food are not enough to cover this excessive secretion, a person develops. It develops very slowly, often unnoticed by the patient, gradually damaging the nervous system. Due to the complexity of diagnosis and the rarity of insulinoma, a patient may be treated by a neurologist or psychiatrist for several years without results until the symptoms of hypoglycemia become apparent.

It is important to know! A novelty recommended by endocrinologists for Permanent Diabetes Control! All you need is every day...

What is insulinoma

Among others important functions the pancreas provides our body with hormones that regulate carbohydrate metabolism- Insulin and glucagon. Insulin is responsible for removing sugar from the blood to the tissues. It is produced special kind cells that are located in the tail of the pancreas - beta cells.

Insulinoma is a neoplasm consisting of these cells. It belongs to hormone-secreting tumors and is able to independently synthesize insulin. The pancreas releases this hormone when the concentration of glucose in the blood increases. The tumor produces it always, without regard to physiological needs. The larger and more active the insulinoma, the more insulin it produces, which means that blood sugar decreases more.

Diabetes and high blood pressure will be a thing of the past

Diabetes is the cause of almost 80% of all strokes and amputations. 7 out of 10 people die due to blockage of the arteries of the heart or brain. In almost all cases, the reason for such a terrible end is the same - high sugar in blood.

It is possible and necessary to knock down sugar, otherwise there is no way. But this does not cure the disease itself, but only helps to fight the effect, and not the cause of the disease.

The only medicine that is officially recommended for the treatment of diabetes and it is also used by endocrinologists in their work is this.

The effectiveness of the drug, calculated according to the standard method (the number of recovered patients to the total number of patients in a group of 100 people who underwent treatment) was:

• Normalization of sugar 95%
• Elimination of vein thrombosis - 70%
• elimination strong heartbeat – 90%
• Getting rid of high blood pressure – 92%
• Increase energy during the day, improve sleep at night - 97%

Manufacturers are not commercial organization and financed with state support. Therefore, now every resident has the opportunity.

This tumor is rare, affecting one in 1.25 million people. Most often it is small, up to 2 cm, located in the pancreas. In 1% of cases, insulinoma can be located on the wall of the stomach, duodenum, spleen, liver.

A tumor only half a centimeter in diameter is capable of producing an amount of insulin that will cause glucose to drop below normal. At the same time, it is quite difficult to detect it, especially with atypical localization.

Insulinoma most often affects adults of working age, women 1.5 times more often.

Most often, insulinomas are benign (ICD-10 code: D13.7), after exceeding the size of 2.5 cm, signs of a malignant process begin in only 15 percent of neoplasms (code C25.4).

Why develop and how

The exact cause of insulinoma development is unknown. There are suggestions about the presence of a hereditary predisposition to pathological cell growth, about single failures in the adaptive mechanisms of the body, but these hypotheses have not yet been scientifically confirmed. Only the association of insulinoma with multiple endocrine adenomatosis, a rare genetic disease in which hormone-secreting tumors develop. In 80% of patients, formations are observed in the pancreas.

Insulinomas can have any structure, and areas within the same tumor often differ. This is due to the different ability of insulin to produce, store and secrete insulin. In addition to beta cells, the tumor may contain other pancreatic cells that are atypical and functionally inactive. Half of the neoplasms, in addition to insulin, are also capable of producing other hormones - pancreatic polypeptide, glucagon, gastrin.

Less active insulinomas are thought to be larger and more likely to become malignant. Perhaps this is due to less severe symptoms and late detection of the disease. The frequency of hypoglycemia and the rate of increase in symptoms are directly related to tumor activity.

The autonomic nervous system suffers from a lack of glucose in the blood, the functioning of the central nervous system is disrupted. Periodically low sugar blood has an impact on higher nervous activity, including thinking and consciousness. It is with damage to the cerebral cortex that the often inadequate behavior of patients with insulinoma is associated. Metabolic disorders lead to damage to the walls of blood vessels, due to which cerebral edema develops and blood clots form.

Signs and symptoms of insulinoma

Insulinoma produces insulin constantly, and pushes it out of itself with a certain frequency, so episodic attacks of acute hypoglycemia are replaced by relative calm.

Also, the severity of the symptoms of insulinoma is affected by:

1. Features of nutrition. Sweet lovers will feel problems in the body later than adherents of protein foods.
2. Individual sensitivity to insulin: some people pass out when blood sugar is less than 2.5 mmol / l, others can withstand such a decrease normally.
3. The composition of the hormones that the tumor produces. With a large amount of glucagon, symptoms will appear later.
4. tumor activity. The more hormone is released, the brighter the signs.

The symptoms of any insulinoma are due to two opposite processes:

1. The release of insulin and, as a consequence, acute hypoglycemia.
2. The production by the body in response to an excess of insulin of its antagonists, hormones-opponents. These are catecholamines - adrenaline, dopamine, norepinephrine.

Most often, attacks are observed in the morning on an empty stomach, after physical activity or psycho-emotional stress, in women - before menstruation.

Attacks of hypoglycemia are quickly stopped by the intake of glucose, therefore, in the first place, the body reacts to a decrease in sugar with an attack of acute hunger. Most patients unconsciously increase their intake of sugar or sweets and start eating more often. A sudden pathological craving for sweets without other symptoms may be due to a small or inactive insulinoma. As a result of a violation of the diet, weight begins to grow.

A small part of patients behaves in the opposite way - they begin to feel an aversion to food, they lose a lot of weight, and correction of exhaustion has to be included in their treatment plan.

Diagnostic measures

Because of the striking neurological signs, insulinoma is often mistaken for other diseases. Epilepsy, hemorrhages and blood clots in the brain can be misdiagnosed, vegetovascular dystonia, psychoses. A competent doctor, if insulinoma is suspected, spends several laboratory research, and then confirms the alleged diagnosis by visual methods.

In healthy people, the lower limit of sugar after an eight-hour fast is 4.1 mmol / l, after a day it drops to 3.3, after three - up to 3 mmol / l, and in women the decrease is slightly greater than in men. In patients with insulinoma, sugar drops to 3.3 already in 10 hours, and a day later acute hypoglycemia with severe symptoms develops.

Based on these data, hypoglycemia provocation is performed to diagnose insulinoma. It is a three-day fast in a hospital, in which only water is allowed. Every 6 hours do an analysis for insulin and glucose. When sugar drops to 3 mmol / l, the periods between analyzes are reduced. The test is terminated when the sugar drops to 2.7 and symptoms of hypoglycemia appear. They are stopped with an injection of glucose. On average, the provocation ends after 14 hours. If the patient survives 3 days without consequences, he has no insulinoma.

Importance in diagnostics, it also has the definition of proinsulin. It is a precursor to insulin produced by beta cells. After leaving them, the proinsulin molecule is cleaved into C-peptide and insulin. Normally, the proportion of proinsulin in the total amount of insulin is less than 22%. With benign insulinoma, this figure is higher than 24%, malignant - more than 40%.

An analysis for C-peptide is performed in patients with suspected mental disorders. This is how cases of insulin administration by injection without a doctor's prescription are calculated. Insulin preparations do not contain C-peptide.

Diagnosis of the location of insulinoma in the pancreas is made using imaging methods, their efficiency is above 90%.

Doctor medical sciences, head of the Institute of Diabetology - Tatyana Yakovleva

I have been studying diabetes for many years. It's scary when so many people die and even more become disabled due to diabetes.

I hasten to announce the good news - the Endocrinological Research Center of the Russian Academy of Medical Sciences managed to develop a drug that is completely curative diabetes. On the this moment the effectiveness of this drug approaches 98%.

Another one good news: The Ministry of Health has achieved acceptance, which compensates for the high cost of the drug. In Russia, diabetics until March 6 (inclusive) can get it - For only 147 rubles!

Can be used:

1. Angiography is the most efficient method. With its help, an accumulation of vessels that provide blood supply to the tumor is detected. Based on the size of the feeding artery and the network of small vessels, one can judge the location and diameter of the neoplasm.
2. Endoscopic ultrasonography- allows you to detect 93% of existing tumors.
3. CT scan- reveals a tumor of the pancreas in 50% of cases.
4. Ultrasound- effective only in the absence of excess weight.

Treatment

Insulinoma is tried to be removed as early as possible, immediately after diagnosis. All the time before the operation, the patient receives glucose in food or intravenously. If the tumor is malignant, then surgical intervention chemotherapy is needed.

Surgical intervention

Most often, an insulinoma is located on the surface of the pancreas, has clear edges and a characteristic red-brown color, so it is easy to remove without damaging the organ. If the insulinoma inside the pancreas is too small, has an atypical structure, the doctor may not find it during the operation, even if the localization of the tumor was established during the diagnosis. In this case, the intervention is stopped and postponed for some time until the tumor grows and can be removed. At this time, conservative treatment is carried out to prevent hypoglycemia and disorders of nervous activity.

At reoperation Again, they seek to detect insulinoma, and if this fails, they remove part of the pancreas or liver with a tumor. If the insulinoma is with metastases, it is also necessary to perform a resection of a part of the organ in order to minimize the tumor tissues.

Conservative treatment

Symptomatic treatment Insulinoma in anticipation of surgery is a diet high in sugars. Preference is given to products with, the assimilation of which ensures a uniform supply of glucose into the blood. Episodes of acute hypoglycemia are treated with fast carbohydrates, usually juices with added sugar. If there is severe hypoglycemia with impaired consciousness, the patient is administered glucose intravenously.

If, due to the patient's health condition, the operation is delayed or impossible at all, phenytoin and diazoxide are prescribed. The first drug is an antiepileptic drug, the second is used as a vasodilator in hypertensive crises. These drugs are united by a common side effect -. Using this deficiency for good, you can keep blood glucose at a level close to normal for years. Simultaneously with diazoxide, diuretics are prescribed, as it retains fluid in the tissues.

The activity of small pancreatic tumors can be reduced with verapamil and propranalol, which can inhibit insulin secretion. For the treatment of malignant insulinoma, octreotide is used, it prevents the release of the hormone and significantly improves the patient's condition.

Chemotherapy

Chemotherapy is needed if the tumor is malignant. Streptozocin is used in combination with fluorouracil, 60% of patients are sensitive to them, 50% develop complete remission. The course of treatment lasts 5 days, they will have to be repeated every 6 weeks. The drug has a toxic effect on the liver and kidneys, therefore, in the intervals between courses, drugs are prescribed to support them.

What to expect from the disease

After the operation, the level of insulin quickly decreases, blood glucose rises. If the tumor is detected on time and removed completely, 96% of patients recover. The best outcome is observed in the treatment of small benign tumors. The effectiveness of treatment of malignant insulin is 65%. Relapses occur in 10% of cases.

With small changes in the central nervous system, the body copes on its own, they regress in a few months. Severe nerve damage, organic changes in the brain are irreversible.

Be sure to study! Do you think lifelong pills and insulin are the only way to keep sugar under control? Not true! You can verify this yourself by starting to use ...