Navigating Insulinomas: Diagnosis and Management Strategies

The symptoms of insulinoma go unnoticed in the beginning. When symptoms appear, they can vary depending on the severity of the condition. Insulinoma may have the following symptoms -

• Blurred Vision
• Dizziness
• Weakness
• To Sweat
• Change In Appetite
• Sudden Weight Gain
• Mood Changes
• Anxiety And Irritability
• Confusion
• Shocks

More serious symptoms of insulinoma can affect the brain. Sometimes, the symptoms appear to be similar to those of the neurological disorder epilepsy. Symptoms seen in more severe cases may include:

• Seizures
• Fast Heart Rate
• Inability To Concentrate
• Coma

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In some cases, insulinoma may grow larger and spread to other parts of the body. When this happens, the following symptoms may occur:

• Stomach Ache
• Back Pain
• Diarrhea
• Jaundice

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Tumors usually appear without warning. These affect more females than males at birth and usually develop in people between 40 and 60 years of age. About 10% of insulinomas are cancerous. Cancerous tumors are more common in people who have multiple endocrine neoplasia type 1.

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Blood tests and imaging tests can help the doctor diagnose insulinoma.

Blood Test
A doctor will do a blood test to check blood sugar and insulin levels. Low blood sugar level along with high insulin level indicates the presence of insulinoma. The test may also detect:

• Other Hormones That Affect Insulin Production
• Proteins That Inhibit Insulin Production
• Medications That Cause The Pancreas To Release More Insulin

If a blood test shows that you have insulinoma, your doctor will advise you not to eat anything. These fasts last for 72 hours, but recent research has shown that 48-hour fasts are also effective. You will stay in the hospital during the fast so that the doctor can monitor your blood sugar levels. They will measure your blood sugar levels every 4 to 6 hours. If you have an insulinoma, your blood sugar levels will likely drop very low within 48 hours of starting to fast.

Imaging Tests
For testing, the doctor may perform imaging tests such as CT scan or MRI. These tests help them determine the location and size of the insulinoma. If the tumor cannot be detected using CT scan or MRI, they may perform endoscopic ultrasound. During an endoscopic ultrasound, the doctor puts a long, flexible tube (or endoscope) into your mouth and down through the stomach and small intestine. The tube contains an ultrasound probe, which emits sound waves that produce images of your pancreas.

Once the doctor finds an insulinoma, they will take a small sample of tissue. This tissue sample can be used to determine whether a tumor is cancerous.

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The best treatment for insulinoma is to remove the tumor by surgery. If there is more than one tumor, a small part of the pancreas may also be removed. The location and number of tumors determine what type of surgery will be used.

• Laparoscopic Surgery – If the tumor is small then laparoscopic surgery is the preferred option. This is a low risk procedure. During laparoscopic surgery, a surgeon makes several small incisions in your abdomen and inserts a laparoscope through the incisions. The camera will be able to see inside the abdomen and then the surgeon will find and remove the insulinoma.
• Other Surgeries—If you have more than one insulinoma, part of the pancreas may need to be removed. This usually cures the insulinoma. Sometimes, part of the stomach or liver may also be removed.
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Other Treatments
In rare cases, removing the insulinoma will not cure it. This usually happens when tumors are cancerous. Treatment for cancerous insulinoma includes:

• Radiofrequency ablation: This uses radio waves to kill cancer cells in the body.
• Cryotherapy: Cryotherapy involves the use of extreme cold to destroy cancer cells.
• Chemotherapy: Chemotherapy is an aggressive form of chemical drug therapy that helps destroy cancer cells.

The doctor may also prescribe medications to help manage your blood sugar levels if surgery is not effective.

In general, people with cancerous insulinomas are more likely to have complications. This is especially true when the tumor has spread to other organs. Surgeons cannot completely remove all tumors. In this case, additional treatment and care is needed. A small number of people with insulinomas may develop diabetes after surgery. This usually only happens when the entire pancreas or a large part of the pancreas is removed.

Insulinoma is largely curable if the tumor is removed. After surgery, it heals completely without complications. However, it is possible that this may happen again in the future, but the probability of this is very less.

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You can reduce your risk of hypoglycemia by eating a balanced diet to prevent and manage insulinomas. This diet should mainly consist of fruits, vegetables and lean proteins.