Hypoglycemia – This is a dangerous condition that develops against the background of a decrease in blood sugar, which can be caused both by a lack of glucose in the body and by a large amount of insulin. A lot of insulin can be with a benign tumor of the pancreas – insulinoma. An insulinoma is a benign growth of pancreatic β-cells that secrete insulin. In very rare cases, insulinoma can be malignant.
Insulinoma affects people aged 40-60 years; in childhood, the pathology is quite rare.
Pathogeny of pancreatic tumor development – insulinomas
The main manifestation of a pancreatic tumor ( insulinoma ) is hypoglycemia, which appears from the uncontrolled secretion of insulin by Langerhans cells. In a normal body, when glucose intake falls, insulin secretion decreases sharply. In pancreatic tumor cells, this mechanism is disrupted, which creates conditions for the development of hypoglycemic syndrome.
The most sensitive cells to lower blood sugar are brain cells, because glucose is their main energy substrate. Therefore, in the presence of such a tumor of the pancreas in humans, the phenomenon of neuroglycopenia is observed, and with long-term hypoglycemia, dystrophic changes in the central nervous system develop. With the development of hypoglycemia, contrainsular hormones are released into the blood. norepinephrine, glucagon, somatotropin, cortisol, which form adrenergic symptoms.
How not to miss insulinoma? Clinical manifestations of insulinoma
In the clinical course of insulinoma, a phase of relative well-being and pronounced clinical manifestations of hypoglycemia and reactive hyperadrenalemia are distinguished. As for the period of well-being, in this period the only symptom may be increased appetite and obesity.
An attack of hypoglycemia with insulinoma develops on an empty stomach in the morning, after a long break in eating. The glucose content during an attack is below 2.5 mmol/l.
The clinical manifestations of neuroglycopenic manifestations are very similar to psychiatric and neurological abnormalities. These patients develop confusion, ataxia, muscle weakness, and headache. It happens that the attack is accompanied by psychomotor agitation, hallucinations, motor restlessness, euphoria, unmotivated aggression. The adrenal system reacts to all this with the appearance of tremor and fear, tachycardia, cold sweat and paresthesia.
With further progression of an attack with insulinoma, an epileptic seizure, loss of consciousness and coma may develop. The attack is well stopped by intravenous administration of glucose. Upon returning to consciousness, patients do not remember what happened.
Complications of a hypoglycemic attack with insulinoma
During such an attack with insulinoma, myocardial infarction may develop against the background of acute malnutrition of the heart muscle, signs of local damage to the nervous system may develop, which can be perceived as stroke.
In the presence of insulinoma and frequently recurring such processes, chronic hypoglycemia develops. It is manifested by neurological symptoms in interictal periods. This is a decrease in memory, apathy, decreased mental activity, myalgia, visual impairment. Men develop impotence.
When examining patients with insulinoma, a neuropathologist reveals asymmetry of tendon and periosteal reflexes, decreased abdominal reflexes, the presence of pathological reflexes Rossolimo, Marinescu – Radovich, Babinsky. Noteworthy is nystagmus and gaze paresis. Therefore, such patients are often misdiagnosed due to the polymorphism and non-specificity of clinical manifestations.
How to detect insulinoma? Methods for diagnosing insulinoma
To confirm or refute the presence of insulinoma, they are guided by the pathognomonic Whipple triad for it. It is revealed by conducting a test with starvation. Whipple's triad consists in the presence of neuropsychic manifestations during fasting, a drop in glucose levels to 2.78 mmol / l and the effectiveness of stopping this condition by administering glucose intravenously.
If the result is positive, further diagnosis of insulinoma includes ultrasound of the pancreas and abdomen, MRI of the pancreas, scintigraphy, diagnostic laparoscopy.
Insulin needs to be differentiated from dumping – syndrome, adrenal insufficiency, alcoholic and drug hypoglycemia, adrenal cancer, galactosemia.
Methods of treatment of insulinoma. Prognosis for insulinoma
Preferred treatment tactics – surgical. Surgery can be of different types and volumes. After the operation, its effectiveness is evaluated by dynamic monitoring of glucose levels. Possible postoperative complications in the form of pancreatic necrosis, pancreatic fistula, pancreatitis or peritonitis.
If the insulinoma is inoperable, conservative therapy with epinephrine, glucagon, norepinephrine, glucocorticoids is carried out. When the insulinoma is malignant, chemotherapy is performed.
The prognosis of insulinoma is as follows - in most patients, after surgical removal of insulinoma, clinical recovery is observed. Early diagnosis and timely surgical treatment lead to regression of changes in the CNS. Relapse occurs in only 3% of cases. With a malignant nature of insulinoma, the prognosis is unfavorable.
Patients with insulinoma detected should be registered with a neuropathologist and an endocrinologist.
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