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The adrenal glands and other abdominal endocrine disorders
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
This is an insulin-producing tumour of the pancreas causing the clinical scenario know as Whipple’s triad, i.e. symptoms of hypoglycaemia after fasting or exercise, plasma glucose levels <2.8 mmol/L and relief of symptoms on intravenous administration of glucose.
Liver, biliary system and pancreas
Published in Michael Gaunt, Tjun Tang, Stewart Walsh, General Surgery Outpatient Decisions, 2018
Satyajit Bhattacharya, Adrian O’Sullivan
A positive diagnosis is based on three elements: recognition of probable nature of patient’s symptomspresence of Whipple’s triad: ∝ hypoglycaemic symptoms produced by fasting∝ hypoglycaemia documented during symptomatic episodes∝ symptoms relieved by glucose intakedemonstration that plasma insulin concentration is inappropriately high for the existing levels of plasma glucose. An insulin (IU/ml) to glucose (mg/dl) ratio of greater than 0.3 indicates insulinoma.
Answers
Published in Thomas Hester, Iain MacGarrow, Surgical SBAs for Finals with Explanatory Answers, 2018
Adenocarcinoma is the most common pancreatic cancer. Gastrinoma and insulinoma can occur but have a different symptom set. Gastrinoma (Zollinger-Ellison syndrome) typically presents with upper gastrointestinal bleeding or perforation and multiple duodenal ulcers due to the secretion of gastrin-like substance and subsequent high levels of HCl. Insulinoma patients present with Whipple’s triad of: Attacks of fainting or muscle weakness induced by exercise or starvation.Hypoglycaemia.Symptoms relieved by dextrose given orally or intravenously.
Doege-Potter syndrome in a patient with a giant abdominal solitary fibrous tumor: a case report and review of the literature
Published in Acta Clinica Belgica, 2023
Joris Rötgens, Bruno Lapauw, Guy T’Sjoen
Hypoglycemia is rare in patients without diabetes treatment and warrants further investigation when Whipple’s triad is documented. Whipple’s triad consists of [A] symptoms of hypoglycemia, [B] low plasma glucose concentration (<55 mg/dL), and [C] relief of symptoms following administration of carbohydrates [1]. In such cases the first step is to review the patient’s history in detail. The timing of hypoglycemia (particularly in relationship to meals), the presence of underlying conditions, the use of medication and alcohol all need to be assessed. The initial biochemical evaluation includes measurement of glucose, insulin, proinsulin, C-peptide, beta-hydroxybutyrate and a urinary sulphonylurea screening, all during an episode of hypoglycemia. In addition, insulin antibodies should be examined [2].
Clinical efficacy and safety of dasiglucagon in severe hypoglycemia associated with patients of type 1 diabetes mellitus: a systematic review and meta-analysis
Published in Expert Review of Clinical Pharmacology, 2023
Sagar Dholariya, Deepak Parchwani, Siddhartha Dutta, Ragini Singh
Hypoglycemia remains a clinically notable acute consequence of the treatment of type 1 diabetes mellitus (T1DM) [1]. Whipple’s triad, which includes low plasma glucose level, symptoms of hypoglycemia, and remission of hypoglycemic symptoms after elevation of plasma glucose level, is the most significant evidence of hypoglycemia [2]. Fasting plasma glucose concentrations (FPG) are usually around 3.9 mmol/L or 70.0 mg/dL, while venous glucose levels are generally much lower, especially after late food intake [3,4]. The severity of hypoglycemia is classified into three levels according to the American Diabetes Association (ADA) criteria. Level 1 refers to the blood glucose levels between 54.0 to 70.0 mg/dL or 3.0 to 3.9 mmol/L. Patients and attendants should be warned about the unfavorable outcomes of clinically significant hypoglycemia, and oral glucose therapy is recommended. Level 2 refers to a blood glucose level of ≤54.0 mg/dL (≤3.0 mmol/L) and considers clinically serious hypoglycemia in the presence of altered consciousness, cardiac arrhythmias, and frequent episodes. Level 3 refers to severe intellectual impairment that requires urgent external assistance, and the blood glucose level is expected to be < 35.0 mg/dL or 2.0 mmol/L [5].
EUS-guided lauromacrogol ablation of insulinomas: a novel treatment
Published in Scandinavian Journal of Gastroenterology, 2018
Shanyu Qin, Yongru Liu, Hongjian Ning, Lin Tao, Wei Luo, Donghong Lu, Zuojie Luo, Yingfen Qin, Jia Zhou, Junqiang Chen, Haixing Jiang
Insulinoma, with an incidence of 1–4 per million people per year, is a rare pancreatic islet cell tumor, yet it is the most common neuroendocrine tumor of pancreas and accounts for 1–2% of all diagnosed neoplasms of pancreas [1]. Generally, 90% of the insulinomas are solitary benign tumors measuring less than 2 cm in diameter and occur sporadically [2,3]. As whipple’s triad described, hypoglycemia and neuroglycopenic symptoms are present in patients with insulinoma [4]. Diagnosis of an insulinoma is dependent on the following criteria: blood glucose (BG) less than 3.0 mmol/L (50 mg/dL) with a concomitant level of insulin more than 18 pmol/L (3 mU/L) and an elevated C-peptide level greater than 0.6 ng/mL (0.2 nmol/L) on condition that there is no sulfonylurea in the patient’s plasma [5,6]. While physical exercise and fasting can provoke the symptoms, the administration of carbohydrate helps relieve the symptoms. Although rare, insulinoma can affect quality of life especially for those with severe hypoglycemia and neuroglycopenic symptoms.