Insulinoma refers to a tumor of the beta cells of the islets of Langerhans; although usually benign, it is one of the chief causes of hypoglycemia. An abnormal mass that grows in the beta cells of the pancreas that make insulin. They secrete insulin and are the most common cause of low blood sugar caused by having too much insulin in the body. This file is designed by Mohammad saleh Moallem

1. Clinical manifestations
Mr. Wang
A 47 years old engineer
Case flowchart
in a construction company
History & Origin Recurrence of disease Hospitalization Medical Examination Diagnose Treatment
He had viral fever
and epilepsy
Had viral fever 2 years ago and it
was treated and he discharged. But
later he suffered from following
symptoms in serious cases:
Palpitaition
Fatigue
Irritability
Cold sweet
Limb convulsions
Most of these symptoms would
be relieved by themselves in
about 2 minutes.
Epilepsy
Prescribed drug: Carbamazepine
His family called 120 EMS because of
the above symptoms:
Drop attack (falling down)
Trembeling in hands
Had urinary incontinence
He was unable to respond
He was sent to the ward
The results of detailed labratory examination:
The serum cortisol levels, growth hormone, adrenocorticotropic
hormone, and thyroid hormone were normal. Tumor markers:
Alpha-Fetal Protein (AFP), carcinoembryonic antigen (CEA), CA19-
9, and CA125 were all in the normal range.
After admission, the doctor gave further examination to find
out the cause.
Preliminary diagnose: Pancreatic Insulinoma
Examinations 1 year after
being discharged from hosp.
BGL: 2.6 mmol/L
Ca2+
: 2.9 mmol/L
PTH: 276 pg/ml
B-ultrasound examination of thyroid
Physical and Lab. Examinations
After admission, the doctor gave
further examination to find out the
cause. These tests were done at first
time when patient came to hospital.
Results of oral glucose tolerance test,
insulin and C-peptide release test
after admission were obtained.
Differential
Diagnose
Insulinoma
An abnormal mass that
grows in the beta cells of the
pancreas that make insulin.
1. Only about 10% of insulinomas are
malignant, but all-cause fasting
hypoglycemia. 2. Glucose and insulin
levels are measured during symptoms
(either spontaneous or induced by
fasting during hospitalization). 3.
Endoscopic ultrasonography has > 90%
sensitivity for locating the tumor;
positron emission tomography (PET)
also may be used.
Pancreatic
adenoma Pancreatectomy
Partial
The results of the CT: The mass was
significantly enhanced in the arterial
phase; the enhancement degree of
mass decreased in the parenchymal
phase. Note: Pancreatic adenoma is
more likely to be considered.
Surgery
After diagnosing insulinoma, Mr. Wang was
transferred to the surgical department to go
under surgery. Blood glucose, insulin, and
other indicators returned to normal after the
operation.
After 1year of being discharge he comeback
One year later he came back with severe
abdominal pain and then after confirming
the presence of a duodenal ulcer, the doctor
prescribed the following drugs:
a. Lots of fluid infusions
b. Furosemide
c. Salmon Calcitonin
d. Proton pump inhibitor
e. Corrected hypercalcemia
PBL4-1
Flowchart
4
May, 2022
Teacher
Prof. Yang Qing 杨青老师
Students
默汉 张美丽
灵尚 索菲雅
阿朵 娜迪
张笛夕 迪莉
艾里克
Saleh Ghazal
Razy
Hannah Saffiyah
Aliakbar
Nadia
Zandile
Dikshita
卡林
Kalin
Medical history of patient gained by
EMS staffs and the doctor and they
got that he had seizure in the past
and had viral fever 2 years ago.
Physical examination was
performed on him
HIG
H
Lo
B-ultrasound examination of the
thyroid in the neck, parathyroid
adenoma was found, clinically
diagnosed as "hyperparathyroidism".
The main symptom is fasting
hypoglycemia. Drugs that
block insulin secretion such
as diazoxide & octreotideare
used for patients not
responding to surgery.
Parathyroid adenoma was found
and clinically diagnosed as
hyperparathyroidism, and the
tumor was surgically removed.
A scheme of the cellular structures important for physiological
regulation of insulin secretion in pancreatic beta cells.
EMS arrived and carried
out first aid and checked
his blood glucose level.
BGL: 2.0 mmol/L ↓low
Injected 5% IV glucose
He then went to the hospital for
examination and was diagnosed with:
However, he stopped the medication
when he found that it had no effect!
Increased weight by 10 Kg in 2
years and because of epilepsy
his company suspended him and
then as a result he was in low
mood and had a poor sleep. He
often wakes up in early morning
with nightmares and cold sweet.
CT plain scan + enhanced abdominal transverse section image
Mr. Wang was sent to the ward
for physical examinations.
The results of the oral glucose tolerance test, insulin, and C-peptide test:
According to Mr. Wang's condition, the doctor suspected he had insulinoma, so he
underwent a hunger test and abdominal CT examination. After fasting for 23 hours,
a hypoglycemic reaction was induced, so the test was terminated, blood was taken
immediately for a test (the results are shown below), and food was ordered.