Clinical Characteristics and Biochemical Evaluation of 11 Patients with Hypoglycemic Episodes and CT Findings Suggesting Malignant Insulinoma
| Clinical characteristic | Biochemical evaluation at end-of-fasting test* | Clinical course after imaging | |||||||
| Patient no. | Age (y) | Sex | First symptoms (mo†) | Duration of fasting (h) | Glucose (mmol/L) | C-peptide (nmol/L) | Insulin (mU/L) | Treatment after imaging | Remission‡ status |
| 1 | 62 | M | 1 | 20 | 1.9 | 0.44 | 3.0 | TE | Complete response |
| 2 | 72 | M | 36 | 72 | 2.6 | 1.1 | 16 | DS | Partial response |
| 3 | 54 | F | 24 | 72 | 1.4 | 2.1 | 31 | PRRT | Partial response |
| 4 | 48 | F | 36 | 72 | 1.9 | 0.83 | 78 | PRRT | Persistent disease |
| 5 | 53 | M | 6 | 14 | 1.8 | 2.0 | 143 | TE | Complete response |
| 6 | 66 | F | 5 | Not done | Not done | Not done | Not done | DP + DS + PRRT | Partial response |
| 7 | 74 | M | 1 | 72 | 2.3 | 0.43 | 7.0 | none | Persistent disease |
| 8 | 68 | M | 9 | Not done | Not done | Not done | Not done | TE + Chemotherapy | Persistent disease |
| 9 | 68 | M | 8 | 10 | 1.6 | 6.0 | 34.9 | TE | Persistent disease |
| 10 | 78 | F | 1 | 12 | 2.5 | 3.3 | 80 | TE | Not available§ |
| 11 | 55 | M | 3 | 4 | 2.3 | 0.79 | 20 | DP | Complete response |
↵* In 9 of 11 patients, fasting test was performed. Patient 6 presented with confusion and unconsciousness due to hypoglycemia; fasting test was not performed, but CT scans revealed liver lesions suggestive of malignancy.
↵† Eight patients (1, 5, 6, 7, 8, 9, 10, and 11) who had neuroglycopenic symptoms less than 10 mo before recruitment did not receive specific medical therapy. Remaining 3 patients had neuroglycopenic symptoms for 24–36 mo before recruitment. They were treated individually with surgery, diazoxide, somatostatin analogs, and PRRT.
↵‡ Remission status at termination of study.
↵§ Multimorbid patient who died of liver failure shortly after surgery.
TE = tumor enucleation or whipple surgery; DS = debulking surgery; DP = distal pancreatectomy.