scholarly journals Metastatic Insulinoma Presenting With Post-Prandial Hypoglycemia

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A999-A1000
Author(s):  
Monique Maher ◽  
Dimpi Desai ◽  
Mandeep Bajaj
Keyword(s):  
Blood Glucose ◽  
Neuroendocrine Tumor ◽  
Regional Lymph Node ◽  
Glucose Monitoring ◽  
Insulin Level ◽  
Pancreatic Neuroendocrine Tumor ◽  
Needle Aspiration ◽  
Low Grade ◽  
C Peptide ◽  
Fasting Hypoglycemia

Abstract Background: Patients with an insulinoma, a type of pancreatic neuroendocrine tumor, typically present with fasting hypoglycemia (1). Occurrence of exclusively postprandial hypoglycemia as a result of a predominantly proinsulin-secreting metastatic neuroendocrine tumor is rare (2). Clinical Case: A 69-year-old man presented with episodes of postprandial blurry vision, sweating and confusion for the last two years that were becoming more frequent over the last several weeks. Self-monitoring of blood glucose at home revealed postprandial hypoglycemia (45-70mg/dl) and symptoms were consistent with Whipple’s triad. Continuous glucose monitoring over 14-days via Dexcom G6 showed no nocturnal or fasting hypoglycemia and revealed only postprandial hypoglycemia within one-two hours after meals. Laboratory measurements were performed at 8am in fasting state which revealed a blood glucose of 97mg/dl, insulin level 7.8 µIU/ml (2-21 µIU/ml), c-peptide 1.67 ng/ml (1.1-4.4 ng/ml) and elevated proinsulin level of 39 pmol/l (<8.0 pmol/l). An outpatient fast was conducted in the clinic, and when serum blood glucose dropped to 47mg/dL (21 hours after the initiation of the fast), insulin (6 µIU/ml) and c-peptide (2.0ng/ml) levels were detectable with an elevated proinsulin (20.8pmol/L) level. CT abdomen and pelvis showed a 1.6cm hyperenhancing lesion in the distal body of the pancreas. He underwent endoscopic ultrasonography with fine-needle aspiration, confirming the diagnosis of a pancreatic neuroendocrine tumor. Distal pancreatectomy and splenectomy were performed to resect the tumor which led to resolution of his symptoms. Pathology revealed a low grade well-differentiated neuroendocrine tumor with lymphovascular invasion and regional lymph node metastases. Conclusion: Pancreatic neuroendocrine tumor should be considered in post-prandial hypoglycemia, even in the absence of fasting hypoglycemia. Measuring proinsulin is essential in the diagnostic workup of insulinoma causing hypoglycemia References: 1. Placzkowski KA, Vella A, Thompson GB, Grant CS, Reading CC, Charboneau JW, et al. Secular trends in the presentation and management of functioning insulinoma at the Mayo Clinic, 1987-2007. J Clin Endocrinol Metab. 2009;94(4):1069-73.2. Murtha TD, Lupsa BC, Majumdar S, Jain D, Salem RR. A Systematic Review of Proinsulin-Secreting Pancreatic Neuroendocrine Tumors. J Gastrointest Surg. 2017;21(8):1335-41.

scholarly journals The Impact of Repeating Endosonography with Confocal Endomicroscopy for the Diagnosis of Cystic Neuroendocrine Tumor

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Iqra Haq ◽  
Somashekar G. Krishna ◽  
Bhaveshkumar Patel ◽  
Thavam Thambi-Pillai ◽  
Chencheng Xie ◽  
...  
Keyword(s):  
Neuroendocrine Tumor ◽  
Neuroendocrine Tumors ◽  
Pancreatic Pseudocyst ◽  
Incidental Finding ◽  
Pancreatic Neuroendocrine Tumor ◽  
Needle Aspiration ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
The Impact

Cystic pancreatic neuroendocrine tumors represent around 13% of all neuroendocrine tumors (Hurtado-Pardo 2017). There has been an increase in the incidence of cases due to improvement in imaging modalities. This is a case of a 68-year-old male with the incidental finding of a pancreatic cyst on CT. Initial Endoscopic Ultrasound with Fine Needle Aspiration (EUS-FNA) showed sonographic and cytology features suggestive of a pancreatic pseudocyst. However the cyst persisted with no change in size after aspiration leading to a follow-up EUS- FNA, which was combined with needle based confocal laser endomicroscopy (nCLE). The nCLE features were consistent with a cystic pancreatic neuroendocrine tumor, which was later confirmed on histology after surgical resection.

scholarly journals Review of Salivary Gland Neoplasms

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Victor Shing Howe To ◽  
Jimmy Yu Wai Chan ◽  
Raymond K. Y. Tsang ◽  
William I. Wei
Keyword(s):  
Salivary Gland ◽  
Regional Lymph Node ◽  
Postoperative Radiotherapy ◽  
Surgical Excision ◽  
Needle Aspiration ◽  
Low Grade ◽  
Malignant Tumours ◽  
Parotid Glands ◽  
Salivary Gland Tumours ◽  
Mri Scans

Salivary gland tumours most often present as painless enlarging masses. Most are located in the parotid glands and most are benign. The principal hurdle in their management lies in the difficulty in distinguishing benign from malignant tumours. Investigations such as fine needle aspiration cytology and MRI scans provide some useful information, but most cases will require surgical excision as a means of coming to a definitive diagnosis. Benign tumours and early low-grade malignancies can be adequately treated with surgery alone, while more advanced and high-grade tumours with regional lymph node metastasis will require postoperative radiotherapy. The role of chemotherapy remains largely palliative. This paper highlights some of the more important aspects in the management of salivary gland tumours.

scholarly journals Investigation of Salivary Gland Pathology

2017 ◽  
pp. 29
Author(s):  
M. Zulfath Nihara ◽  
K. Udhaya Chandrika ◽  
R. Vijaya Sundari ◽  
Tan Shi Yi ◽  
Maya Ramesh
Keyword(s):  
Salivary Gland ◽  
Regional Lymph Node ◽  
Surgical Excision ◽  
Needle Aspiration ◽  
Low Grade ◽  
Malignant Tumours ◽  
Parotid Glands ◽  
Salivary Gland Tumours ◽  
Mri Scans ◽  
Salivary Gland Pathology

Salivary gland pathology is diverse in nature and mainly inflammatory or neoplastic. Salivary gland tumours present as painless enlarging masses. Most of the tumours are located in parotid glands and many of them are benign. The management of these tumours is difficult just like the diagnosis of benign and malignant tumours. Fine Needle Aspiration Cytology (FNAC) and Magnetic Resonance Imaging (MRI) scans provide some useful information in diagnosis, but most of the tumours will require surgical excision as a means of coming to a definitive diagnosis. Surgical approach is adequate for benign tumours and early low grade malignancies whereas post operative radiotherapy is needed for more advanced and high grade tumours with regional lymph node metastasis. The role of chemotherapy remains largely palliative. This article throws light on some of the more important aspects in the investigations of salivary gland pathologies.

scholarly journals Immunotherapy-Related Autoimmune Diabetes Mellitus and Exogenous Insulin Antibody Syndrome in a Patient With Metastatic Oral Squamous Cell Carcinoma

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A387-A388
Author(s):  
Maimoona Bahlol ◽  
Yufei Dai
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Insulin Lispro ◽  
Autoimmune Diabetes ◽  
Venous Blood ◽  
Insulin Level ◽  
Insulin Antibody ◽  
Diabetic Patients ◽  
Exogenous Insulin ◽  
Fasting Hypoglycemia

Abstract Introduction: Exogenous insulin antibody syndrome (EIAS) is a rare condition characterized by wide glycemic excursions and recurrent hypoglycemia in the presence of high insulin antibody titers. It has been described in diabetic patients treated with exogenous insulin. Programmed death ligand 1 (PD-L1) inhibitors are known to cause autoimmune diabetes mellitus, but PD-L1-related EIAS has not yet been reported to our best knowledge. Case Description: A 63 years old Caucasian man with history of recurrent oral squamous cell cancer presented to emergency room with polyuria, polydipsia, nausea, and vomiting 3 months after initiation of immunotherapy (Durvalumab and cetuximab). He had no prior history of diabetes mellitus or hypoglycemia. He was admitted to hospital for management of diabetic ketoacidosis (Anion gap of 24 mEq/L, venous blood glucose of 805 mg/dL, Venous PH of 7.12, large urine ketone, A1C of 8.9%). After a brief hospital stay, the patient was discharged home on insulin glargine and metformin. His immunotherapy was resumed after hospital discharge. When the patient was seen by Endocrinologist in the clinic, metformin was discontinued and prandial insulin lispro was added. This basal-bolus insulin regimen improved his glycemic control initially. However, without significant changes in his lifestyle or medical condition, he developed worsening postprandial hyperglycemia and recurrent fasting hypoglycemia. Up-titration of his mealtime insulin did not lower postprandial hyperglycemia but possibly worsened fasting hypoglycemia. EIAS was suspected after reviewing his continuous glucose monitoring data. Further work up at this point revealed mildly elevated glutamic acid decarboxylase antibodies (5.9 units/mL, normal range 0.5 - 5.0) and markedly elevated insulin antibody level (77.0 µU/mL, normal range <5). His blood C-peptide was undetectable when his venous blood glucose was 252 mg/dl. In addition, his total insulin level (198 uU/mL) was much higher than his free insulin level (38 uU/mL) following an insulin lispro injection. The patient was diagnosed with EIAS. Switching insulin lispro to insulin aspart while he was on a different immunotherapy medication (Pembrolizumab) immediately reduced his average blood glucose and reduced his total daily insulin dosage by more than 50%. This improvement in glycemic control with insulin aspart only lasted for about 1 week. Unfortunately, the patient’s squamous cancer progressed on immunotherapy. He was referred to hospice care and passed away. Conclusion: Evaluation for EIAS would be reasonable in insulin-treated diabetic patients who develop wide glucose excursions and unexplained fasting hypoglycemia while on immunotherapy.

scholarly journals Comparative study of different models of alloxan-induced diabetes mellitus

2013 ◽  
Vol 94 (6) ◽  
pp. 915-919 ◽  
Author(s):  
R E Jafarova
Keyword(s):  
Diabetes Mellitus ◽  
Weight Loss ◽  
Body Weight ◽  
Blood Glucose ◽  
Blood Glucose Level ◽  
Malonic Dialdehyde ◽  
Insulin Level ◽  
Diene Conjugates ◽  
C Peptide ◽  
Peptide Level

Aim. To compare the clinical course of diabetes mellitus induced by alloxan using classic and modified technique. Methods. Experiments were carried out on mature white mongrel rats, which were divided into two groups: the first group (25 rats) was administered a 200 mg/kg single dose of alloxan (classic model), the second group (25 rats) was administered 150 mg/kg of alloxan at the first day, 100 mg/kg of alloxan at the second day and 100 mg/kg of alloxan at the fourth day. 25 intact rats were examined as a control group. The animals were withdrawn from the experiment by decapitation on the 10th and 21st day, blood and tissue samples were taken for the laboratory testing. The animals’ status (mortality, grooming behavior, body weight, food and water intake) were measured by visual examination. The levels of glucose and lipids were assessed using enzyme colorimetric detection («Human» laboratory kits, Germany, FP-901 analyzer), insulin and C-peptide levels were examined by enzyme-linked immunosorbent assay («Chemwell» analyzer, «DEMENITECKILL-WELLSEE» laboratory kits, Germany); levels of diene conjugates and malonic dialdehyde - using the photocolorimetry based on the colored thiobarbituric acid products. Results. In the first group, the mortality reached 68%, mean weight loss - 41.2%. Blood glucose level at the 10th and 21st days was higher by 370.7 и 146.2% respectively compared to intact animals. Insulin level decreased by 95.8 and 83.7%, C-peptide level - by 96 and 83.7%. In the second group, mortality was 32%, mean body weight loss - 36.5%, blood glucose level at the 10th and 21st days elevated by 364.5 and 151.5%, insulin level decreased by 96.1 and 82.9%, C-peptide level - by 96.0 and 83.7% respectively. A moderate hyperlipidemia was observed in both groups with increased levels of cholesterol, triglycerides, low and very-low density lipoproteids, free fatty acids and decreased levels of high density lipoproteids. The concentration of diene conjugates and malonic dialdehyde increased rapidly to a variable degree depending on the tissue anti-oxidative activity. Conclusion. When diabetes mellitus is modeled by the use of alloxan, an acute form of alloxan-induced diabetes is observed on the 10th day, a chronic form - on the 21st day in both groups. The modified model of alloxan-induced diabetes showed 36% less mortality rate compared to the classic model.

scholarly journals Tuberous Sclerosis Complex with rare associated findings in the gastrointestinal system: a case report and review of the literature

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Larissa Brussa Reis ◽  
Daniele Konzen ◽  
Cristina Brinckmann Oliveira Netto ◽  
Pedro Moacir Braghirolli Braghini ◽  
Gabriel Prolla ◽  
...  
Keyword(s):  
Neuroendocrine Tumor ◽  
Tuberous Sclerosis ◽  
Tuberous Sclerosis Complex ◽  
Pancreatic Neuroendocrine Tumor ◽  
Low Grade ◽  
Gastrointestinal Polyposis ◽  
Colorectal Polyposis ◽  
Predisposing Genes ◽  
History Of ◽  
Gastro Intestinal Tract

Abstract Background Tuberous Sclerosis Complex (TSC) is a complex and heterogeneous genetic disease that has well-established clinical diagnostic criteria. These criteria do not include gastrointestinal tumors. Case presentation We report a 45-year-old patient with a clinical and molecular diagnosis of TSC and a family history of cancer, presenting two rare associated findings: gastrointestinal polyposis and pancreatic neuroendocrine tumor. This patient was subjected to a genetic test with 80 cancer predisposing genes. The genetic panel revealed the presence of a large pathogenic deletion in the TSC2 gene, covering exons 2 to 16 and including the initiation codon. No changes were identified in the colorectal cancer and colorectal polyposis genes. Discussion and conclusions We describe a case of TSC that presented tumors of the gastro intestinal tract that are commonly unrelated to the disease. The patient described here emphasizes the importance of considering polyposis of the gastrointestinal tract and low grade neuroendocrine tumor as part of the TSC syndromic phenotype.

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