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Insulinoma: symptoms
Last reviewed: 23.04.2024
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Symptoms of insulinoma are based on signs of hypoglycemia.
Hypoglycemia is manifested primarily by vasomotor symptoms, such as sweating, palpitations, tachycardia, stenocardia complaints, hypertension, increased appetite and general weakness (due to disturbance of energy processes) and mental changes: agitation or depression, anxiety, inability to concentrate attention, negativism, disorientation , dysarthria, confusion of thinking. Muscular tone rises. Sometimes there is a feeling of numbness of the lips and the tip of the tongue. With the progression of an untreated disease, the CNS disorders come to the fore. The brain receives the necessary energy, mainly through the utilization of glucose, so it is particularly sensitive to recurrent hypoglycemia. Along with severe behavioral disorders, up to a decrease in intelligence, tonic-clonic convulsions, Jackson motor attacks, cerebral ataxia, atheitoid and choreic hyperkinesia can be observed. Combinations of symptoms in individual patients are different, and in the same patient, the clinical manifestations of hypoglycemia are usually stereotyped. In a number of cases, patients with unrecognized insulinoma are treated by a psychiatrist in connection with evolving personality changes.
The attack of hypoglycemia can be resolved independently due to the action of endogenous contrinulsory mechanisms: increased release of catecholamines, cortisol, growth hormone, etc. But usually the intake of easily digestible carbohydrates or intravenous glucose quickly eliminates hypoglycemia. Patients on their own experience are taught to prevent or cope with hypoglycemic attacks. Owing to the necessity of frequent food intake, obesity often develops in patients.
In the acute course of an untreated hypoglycemic state, the confused consciousness can pass into the hypoglycemic coma. The introduction of glucose does not always lead quickly to the elimination of symptoms, because in patients with severe and frequent prolonged hypoglycemic states with loss of consciousness, CNS lesions may develop, up to the necrosis of brain areas.
In patients with insulinoma, more often with adenocarcinoma, abdominal pain may occur. The clinical picture for adenoma and adenocarcinoma is similar, although the latter is often characterized by severe hypoglycemic attacks. The prolonged existence of symptoms of hyperinsulinism (2 years or more) is evidence in favor of adenoma.
Symptoms of insulinoma and hypoglycemia, especially those appearing in the morning on an empty stomach and / or at the end of the day after the end of work (physical activity), a significant improvement in the state of glucose administration make it possible to suspect the presence of organic hyperinsulinism. Its proof is the detection of hypoglycemia - blood glucose 2.77 mmol / L (50 mg%) and lower - and simultaneously inappropriate high concentrations of plasma insulin. But the normal content of insulin does not exclude insulin, in some patients the level of proinsulin in the blood rises.
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