Secular trends in the presentation and management of functioning insulinoma at the mayo clinic, 1987-2007

Kimberly A. Placzkowski, Adrian Vella, Geoffrey B. Thompson, Clive S. Grant, Carl C. Reading, J. William Charboneau, James C. Andrews, Ricardo V. Lloyd, F. John Service

Research output: Contribution to journalArticle

167 Citations (Scopus)

Abstract

Objective: The objective of the study was to assess changes in the presentation and diagnostic and radiological evaluation of patients with surgically confirmed insulinoma at the Mayo Clinic 1987-2007. Methods: A retrospective analysis of patients with insulinoma was conducted. Patients with prior gastric bypass were excluded. Results: A total of 237 patients [135 women (57%)] were identified. Hypoglycemia was reported solely in the fasting state in 73%, the fasting and postprandial state in 21%, and exclusively postprandially in 6%. There was a predominance of men in the postprandial symptom group. Considering the period of study by quartile, outpatient evaluation increased from 35 to 83% and successful preoperative localization improved from 74 to 100% comparing the first to the fourth quartiles. Although the rates of localization by noninvasive techniques remained static at approximately 75%, the addition of invasive modalities has resulted in successful preoperative localization in all patients in the past 10 yr. The sensitivity and specificity of the established diagnostic criteria using insulin, C-peptide, proinsulin, β3- hydroxybutyrate, and glucose response to iv glucagon were greater than 90% and greater than 70%, respectively. Conclusions: Although fasting hypoglycemia is characteristic of patients with insulinoma, postprandial symptoms have been reported with increasing, albeit low, frequency. Trends in the evaluation and preoperative management include a shift to outpatient diagnostic testing, an emphasis on successful preoperative localization to avoid blind pancreatic exploration, and a validation of the diagnostic criteria for hyperinsulinemic hypoglycemia.

Original languageEnglish (US)
Pages (from-to)1069-1073
Number of pages5
JournalJournal of Clinical Endocrinology and Metabolism
Volume94
Issue number4
DOIs
StatePublished - Apr 2009

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Insulinoma
3-Hydroxybutyric Acid
C-Peptide
Glucagon
Insulin
Glucose
Testing
Hypoglycemia
Fasting
Outpatients
Gastric Bypass
Sensitivity and Specificity

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology
  • Biochemistry, medical
  • Endocrinology, Diabetes and Metabolism

Cite this

Placzkowski, K. A., Vella, A., Thompson, G. B., Grant, C. S., Reading, C. C., Charboneau, J. W., ... Service, F. J. (2009). Secular trends in the presentation and management of functioning insulinoma at the mayo clinic, 1987-2007. Journal of Clinical Endocrinology and Metabolism, 94(4), 1069-1073. https://doi.org/10.1210/jc.2008-2031

Secular trends in the presentation and management of functioning insulinoma at the mayo clinic, 1987-2007. / Placzkowski, Kimberly A.; Vella, Adrian; Thompson, Geoffrey B.; Grant, Clive S.; Reading, Carl C.; Charboneau, J. William; Andrews, James C.; Lloyd, Ricardo V.; Service, F. John.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 94, No. 4, 04.2009, p. 1069-1073.

Research output: Contribution to journalArticle

Placzkowski, KA, Vella, A, Thompson, GB, Grant, CS, Reading, CC, Charboneau, JW, Andrews, JC, Lloyd, RV & Service, FJ 2009, 'Secular trends in the presentation and management of functioning insulinoma at the mayo clinic, 1987-2007', Journal of Clinical Endocrinology and Metabolism, vol. 94, no. 4, pp. 1069-1073. https://doi.org/10.1210/jc.2008-2031
Placzkowski, Kimberly A. ; Vella, Adrian ; Thompson, Geoffrey B. ; Grant, Clive S. ; Reading, Carl C. ; Charboneau, J. William ; Andrews, James C. ; Lloyd, Ricardo V. ; Service, F. John. / Secular trends in the presentation and management of functioning insulinoma at the mayo clinic, 1987-2007. In: Journal of Clinical Endocrinology and Metabolism. 2009 ; Vol. 94, No. 4. pp. 1069-1073.
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