Insulinoma

Insulinoma is a rare type of pancreatic tumor that causes excessive insulin production and low blood sugar levels. In this section, we aim to provide a comprehensive overview of the clinical and laboratory manifestations of insulinomas, their differential diagnosis, and available treatment options. Insulinomas can cause a wide range of clinical manifestations, including confusion, dizziness, blurred vision, sweating, palpitations, weakness, fatigue, seizures, and loss of consciousness. Diagnosis of insulinomas relies heavily on laboratory and biochemical testing, which may include plasma glucose and insulin concentrations, C-peptide, pro-insulin, beta-hydroxy-butyrate levels, and a prolonged fast of up to 72 h. Differential diagnosis for insulinomas can be challenging, as symptoms may be similar to other conditions, such as reactive functional hypoglycemia, drug-induced hypoglycemia, and factitious hypoglycemia related to sulfonylureas or glinides. Identifying the cause of hypoglycemia is essential in determining appropriate treatment options. Surgical therapy is the preferred treatment for benign insulinomas, while ablation techniques, such as Endoscopic Ultrasound-guided Ethanol Ablation and Radiofrequency Ablation, may be considered for patients who are not suitable for surgery. Medical therapy, such as personalized dietary counseling and regular blood glucose monitoring, can help control hypoglycemic symptoms. Various medications, such as diazoxide, verapamil, diphenylhydantoin, glucocorticoids, and somatostatin analogs, may be used to manage insulinomas. Patients with malignant insulinomas may require more aggressive treatments, such as surgery, embolization, radiofrequency ablation, chemotherapy, targeted therapy, and peptide receptor radionuclide therapy (PRRT). In conclusion, early detection and treatment of insulinomas are essential to prevent severe complications and improve patient outcomes. A multidisciplinary approach involving endocrinologists, radiologists, and surgeons is necessary to achieve optimal management of insulinomas.