Insulinoma is a rare type of pancreatic neuroendocrine tumour that primarily affects the pancreas, leading to the excessive production of insulin. This condition is typically benign, with a small percentage presenting as malignant.
Due to its capacity to excessively secrete insulin, insulinoma significantly impacts blood sugar levels, leading to hypoglycemia, which is characterised by abnormally low blood glucose levels.
Neuroendocrine Cancer Australia (NECA), is dedicated to assisting individuals with insulinoma and their families as well as other neuroendocrine tumours (NETs). NECA offers a wealth of resources, educational programs, and advocacy efforts aimed at deepening the understanding of NETs, improving patient care, and encouraging research advancements. Patients diagnosed with insulinoma, can engage with NECA’s comprehensive support and information by calling the NET nurse line.
Insulinoma is a type of functional pancreatic neuroendocrine cancer. Insulinomas arise from the beta pancreatic islets cells, that produce insulin These tumours are small, typically less than 2 cm in size, and most patients have a single tumour.
While insulinomas are rare, affecting only about 1 to 5 people per million each year, they are the most common cause of in non-diabetic adults.
The exact cause of insulinoma remains largely unknown. Most insulinomas appear sporadically and are not linked to genetic factors, occurring independently of any known predisposing conditions.
However, in a minority of cases, these tumours are associated with genetic disorders such as Multiple Endocrine Neoplasia Type 1 (MEN1). This genetic condition predisposes individuals to various endocrine tumours, including insulinoma.
The primary effect of insulinoma on the body is the overproduction of insulin, leading to recurrent episodes of hypoglycemia. Insulin is a critical hormone that helps to regulate blood glucose levels by facilitating the uptake of glucose into cells, used for energy.
In insulinoma patients, unregulated insulin secretion causes a rapid decrease in blood glucose levels, which can affect various metabolic processes and brain function, leading to serious health issues if not managed properly.
The symptoms stem directly from the hypoglycemia caused by the tumour’s overproduction of insulin:
Diagnosing insulinoma is a multifaceted process that requires a careful and systematic evaluation of the patient’s symptoms, medical history, and a series of specialised tests. This rare pancreatic neuroendocrine tumour, while typically benign, can have significant effects on a person’s health due to its tendency to produce excessive amounts of insulin, leading to severe hypoglycemia.
Assessment of the frequency, duration, and severity of symptoms associated with hypoglycemia, such as confusion, sweating, and palpitations.
Identifying patterns in these symptoms, especially their occurrence relative to food intake (e.g., fasting or after meals), is crucial.
Given the association of insulinoma with genetic conditions like MEN1, understanding the patient’s family medical history can provide clues about the potential hereditary nature of the disease.
There are two main avenues for assessing the physical state of a patient, including:
Following the initial evaluation, a range of tests is employed to confirm the diagnosis of insulinoma and to determine the exact characteristics of the tumour.
There are two main blood tests that can aid in the diagnosis of insulinoma
Ultrasound, CT, and MRI are crucial in locating the insulinoma within the pancreas. High-resolution imaging can help identify even small tumours. Endoscopic ultrasound involves using an ultrasound probe on an endoscope to get detailed images from within the gastrointestinal tract, providing closer and clearer views of the pancreas.
With most conditions related to neuroendocrine cancer, symptoms can be indicative of other conditions. tests ensure that healthcare professionals can be confident in a correct diagnosis.
Often considered the gold standard for diagnosing insulinoma, this test involves monitoring the patient’s blood glucose and insulin levels over a period of up to 72 hours. A diagnosis is confirmed when there are documented episodes of hypoglycemia accompanied by disproportionately high insulin levels.
This test involves injecting calcium into arteries that supply the pancreas and measuring insulin levels in the blood. Regions that produce an exaggerated insulin response indicate the presence of insulinoma.
The thorough approach to diagnosing insulinoma ensures that the treatment can be appropriately tailored to the individual’s needs, often involving surgical removal of the tumour, which is the definitive treatment for localised disease. The complexity and rarity of insulinoma necessitate a careful and detailed diagnostic process to manage this potentially life-threatening condition effectively.
Insulinoma is characterised by its ability to produce excessive insulin, leading to potentially dangerous levels of hypoglycemia. Although the condition is predominantly benign, effective management is critical to prevent severe health complications.
Let’s explore the various treatment options available for managing insulinoma, from surgical interventions to lifestyle adjustments, and look ahead to emerging research that could revolutionise future treatments.
Surgical removal of the tumour remains the cornerstone of insulinoma treatment. The type of surgery performed depends on the tumour’s characteristics, such as its size and location within the pancreas.
The two main types of procedures include:
Post-surgical care is crucial, as it involves monitoring for any changes in blood glucose levels to ensure the complete removal of the tumour and adjusting treatment plans accordingly.
Despite advancements in localisation techniques and surgical interventions, some insulinomas remain elusive or patients may be unsuitable for surgery due to various reasons such as the risk of recurrent surgery or overall unfitness for surgery. These patients may benefit from medications to control insulin production.
SSAs can decrease insulin secretion and are particularly useful for controlling hypoglycemia in patients with advanced insulinomas.
First line therapy for advanced insulinomas. This drug helps to suppress insulin release, counteracting the effects of the tumour. Diazoxide has proven to be both safe and effective, presenting only minor side effects such as peripheral edema, hyperuricemia, and hirsutism.
For patients who are unable to be considered for surgery, or require a different approach to treatment ,the following treatment options may be considered:
Living with insulinoma requires vigilant management beyond medical treatment. Daily routines and support systems play essential roles in maintaining health and quality of life.
Managing diet is paramount for insulinoma patients, as proper nutrition can help stabilise blood glucose levels. Eating small, frequent meals helps prevent significant blood sugar. Foods that are metabolised slowly, such as whole grains and proteins, help maintain steady glucose levels. Referral and advice from a specialist dietitian is essential.
Continuous monitoring of blood glucose is vital for detecting hypoglycemia early and adjusting treatment plans effectively. Keeping track of blood sugar levels helps patients and healthcare providers manage insulinoma more precisely.
Based on consistent monitoring, dietary plans and medication dosages can be fine-tuned to better control the condition.
The emotional and practical support from dedicated networks is invaluable. Connecting with others facing similar challenges in support groups provides emotional solace and practical tips. Educational materials and updates on new treatments help patients stay informed about managing their condition.
Neuroendocrine Cancer Australia can connect you with a range of patient support groups all across Australia. For advice and support, you can call our NET nurse.
The landscape of insulinoma treatment is evolving with ongoing research and clinical trials:
The field of clinical trials is evolving rapidly for insulinoma in Australia. Here’s how you can find out more:
You can visit the Australian New Zealand Clinical Trials Registry (ANZCTR) website to search for ongoing or upcoming clinical trials for insulinoma in Australia. This registry provides comprehensive details about the trial’s purpose, recruitment status, eligibility criteria, and contact information.
ClinicalTrials.gov is a database of privately and publicly funded clinical studies conducted around the world. You can search for insulinoma studies specific to Australia by filtering the search results by location.
Discussing with a healthcare provider or a specialist in endocrinology can also provide leads on current clinical trials and advice on eligibility and benefits.
The diagnosis and treatment of insulinoma, a rare but significant pancreatic condition, are essential for effective management. Diagnosis involves comprehensive medical evaluations, precise testing, and advanced imaging techniques. Integrating patient history and symptoms with diagnostic tools enables accurate identification of insulinomas, allowing for tailored treatment approaches.
Treatment requires a multifaceted strategy including surgery—often the primary option for localised tumours—medication to control insulin production, and lifestyle changes like diet adjustments and blood sugar monitoring to stabilise the condition and improve life quality. As medical technology and research evolve, new methods enhance treatment efficacy and prospects, offering hope and improved outcomes for patients with insulinoma.
Further information and support for people diagnosed with insulinoma,by is available by calling the NECA NET nurse line.
