| Beta-cell adenomas without hyperinsulinemia with use of highly specific insulin radioimmunoassays: case report and review of literature. | |
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MedLine Citation:
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PMID: 20439243 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To report a case of a proinsulin-secreting islet cell adenoma in which the diagnosis was obscured by an ultraspecific insulin assay. METHODS: We describe the case of a 46-year-old woman, who presented with fasting hypoglycemia and appropriately low insulin values. RESULTS: A prolonged supervised fast produced symptomatic hypoglycemia (20 mg/dL) after only 7 hours. During the entire fasting test, highly specific insulin remained at <3 mIU/L, with a median value (and interquartile range) of 0.9 (0.8 to 2.3) mIU/L, when the glucose concentration was <50 mg/dL. The serum C-peptide level remained high normal (mean +/- SD, 2.7 +/- 0.6 ng/mL; normal fasting levels, 0.8 to 3.9), and no evidence of sulfonylurea use was detected in the patient's urine. Circulating proinsulin levels were persistently high (>200 pmol/L in all determinations when hypoglycemia was present; expected value, <5 pmol/L). Magnetic resonance imaging and endoscopic ultrasonography confirmed the presence of a 2.5-cm tumor in the head of the pancreas. A proinsulin-secreting islet cell tumor was diagnosed. Surgical resection of the tumor was successfully accomplished, but diabetes mellitus developed 4 months postoperatively. CONCLUSION: The diagnosis of a hypoglycemia-producing pancreatic adenoma can be missed when an ultraspecific insulin assay is used. The direct measurement of proinsulin established the diagnosis in this case. |
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Authors:
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Francisco J Gómez-Pérez; Daniel Cuevas-Ramos; Paloma Almeda Valdés; Carlos A Aguilar-Salinas; Roopa Mehta; Juan A Rull |
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Publication Detail:
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Type: Case Reports; Journal Article; Review |
Journal Detail:
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Title: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists Volume: 16 ISSN: 1934-2403 ISO Abbreviation: Endocr Pract Publication Date: 2010 Jul-Aug |
Date Detail:
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Created Date: 2010-08-13 Completed Date: 2010-12-07 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9607439 Medline TA: Endocr Pract Country: United States |
Other Details:
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Languages: eng Pagination: 660-3 Citation Subset: IM |
Affiliation:
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Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. fcojgomezp@aol.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Diagnosis, Differential Endosonography Female Humans Hypoglycemia / blood Insulin / blood Insulinoma / blood*, diagnosis*, secretion, surgery Magnetic Resonance Imaging Middle Aged Pancreatic Neoplasms / blood*, diagnosis*, secretion, surgery Proinsulin / blood*, secretion Radioimmunoassay |
| Chemical | |
Reg. No./Substance:
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11061-68-0/Insulin; 9035-68-1/Proinsulin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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