Insulinoma refers to hormone-active pancreatic neoplasms, which in most cases( 85-90%) have a benign course and in 10-15% - malignant. The most frequent localization of the tumor is the β-cells of the islets of Langerhans, resulting in uncontrolled and increased insulin production. This process quickly leads to the development of hypoglycemia and the corresponding clinical picture.
The insulinoma of the pancreas can occur at any age, but the main age category is patients of average, working age. Children account for up to 5% of cases. The location of the pathological process can be any part of the gland, also rare cases( up to 2%) of extranspankreatic localization are noted. The average size of the neoplasm ranges from 1.5 to 2 cm.
Causes of
Despite some progress in the diagnosis and treatment of this pathology, the causes of insulinoma remain unclear. Various sources put forward assumptions about the genetic predisposition, the influence of bad habits and factors, the failure of adaptation mechanisms. There is also the view that insulinoma is one of the manifestations of multiple adenomatosis, however, all this is still only a hypothesis, and the exact etiology of the tumor remains unknown.
Symptoms of pancreatic insulinoma
Clinical manifestations of the disease largely depend on the degree of hormonal insulin secretion. Latent periods occur without a pronounced symptomatology and can be characterized only by increased appetite and a tendency to gain weight. The acute episodes that come to replace them, represent a pronounced picture of hypoglycemia and an increased content of adrenaline in the blood.
An exacerbation can be caused by a violation of adaptive processes in the central nervous system and the inadequacy of the action of contrinsular factors. A sharp drop in the level of glucose leads to the development of neuroglycopenia, and then the symptoms of the insulinoma of the pancreas resemble acute nervous and psychiatric disorders:
- a sharp headache;
- disorientation;
- confusion;
- anxiety and hallucinations;
- unexplained aggressiveness or euphoria without reason.
In addition to hypoglycemia, the sympathetic-adrenal system reacts, such clinical manifestations as trembling of the limbs, a sense of fear, increased sweating, palpitations. The progression of the process can lead to a loss of consciousness and a coma.
Diagnosis of insulinoma
If you suspect a neoplasm, you need to differentiate it from other pathological conditions with similar signs. Clinical diagnosis of insulinoma consists in carrying out a complex of laboratory, functional and instrumental studies. Of the functional tests, the following tests are most common:
- test with daily fasting, showing a high ratio of insulin to glucose;
- is an insulin suppressive test showing high C-peptide content at low glucose levels;
- is an insulin challenge test that records an elevated serum insulin level in response to glucose administration.
If you have positive samples, connect a variety of instrumental techniques - ultrasound and MRI of the abdominal cavity, scintigraphy, as well as invasive methods - angiography, diagnostic laparoscopy.
Treatment of insulinoma
Treatment measures after verification of the diagnosis consist of an operation, in the absence of contraindications, and concomitant symptomatic therapy. The volume and type of surgery depend on the location and size of the lesion. In different clinical cases, the treatment of insulinoma can be either in its enucleation( complete removal) or in the resection of a pancreas department. During the operation, blood sugar is monitored continuously to assess the effectiveness of the intervention.
If the surgical treatment can not be performed, the tumor is subject to conservative therapy, with the use of hyperglycemic drugs and suppressing insulin products. The first group includes such substances as norepinephrine, corticosteroids, glucagon. The second - Diazoxide and Octreotide, as well as less effective - Diltiazem, Verapamil, Phenytoin. These drugs can reduce the negative manifestations of hypoglycemia.
When a tumor passes into a malignant form, chemotherapy is prescribed for the corresponding severity of the disease pattern. Most often, the basic drug is streptozotocin, but only about 60% of patients show sensitivity to it. In the absence of a sufficient response, the patient is transferred to polychemotherapy, the course of which includes Doxorubicin and 5-fluorouracil.
Forecast and consequences of insulinoma
In a benign and localized process, the prognosis and consequences of insulinoma are in most cases quite favorable. Up to 80% of patients successfully recover after removal of the tumor. The earlier the cause of the disease is identified and its qualitative treatment is carried out, the more successfully the pathological neurological symptomatology is suppressed. In approximately 3% of cases, a recurring course of the disease can be recorded.
Much worse is the prognosis for insulinomas that are of a malignant and multiple nature. Their further consequences largely depend on the location of the process and the degree of metastasis. The decisive role is played by the patient's sensitivity to chemotherapeutic agents, suggesting a good response. All patients who have ever had insulin, are subject to prolonged follow-up at the endocrinologist and neurologist.
Insulinoma in dogs and ferrets
Pancreas nasal formation is not unique to humans - our younger brothers are also prone to this ailment. Insulinoma in dogs and ferrets can occur in different age periods, but most often they suffer from mature and purebred animals. Among ferrets, male individuals have a great propensity for tumorigenesis. The cause of the tumor, as well as in humans, remains unclear.
In domestic animals insulinoma is more often malignant in nature and is accompanied by increased insulin secretion. The main symptoms that can be suspected of an ailment are the following symptoms:
- weight loss;
- mood drop and long periods of sleep;
- marked weakness;
- increased salivation;
- coordination disorder.
In the absence of necessary treatment, the process can lead to convulsive state and subsequent coma. The diagnosis is based on objective data and laboratory results. To remove the tumor, an operation is performed, after which drug therapy with Diazoxide and Prednisone is prescribed. The owners should regularly show the pet to the veterinarian for monitoring the glucose content and correcting possible hypoglycemia.