Insulinoma - Symptoms

Symptoms of insulinoma are based on signs of hypoglycemia.

Hypoglycemia manifests itself primarily by vasomotor symptoms, such as sweating, palpitations, tachycardia, angina complaints, arterial hypertension, increased appetite and general weakness (due to disruption of energy processes) and mental changes: agitation or depression, anxiety, inability to concentrate, negativism, disorientation, dysarthria, confusion. Muscle tone increases. Sometimes a feeling of numbness of the lips and tip of the tongue is observed. With the progression of untreated disease, disorders of the central nervous system come to the fore. The brain receives the necessary energy mainly due to the utilization of glucose, so it is especially sensitive to recurrent hypoglycemia. Along with severe behavioral disorders, up to a decrease in intelligence, tonic-clonic seizures, Jackson motor seizures, cerebral ataxia, athetoid and choreic hyperkinesia can be observed. The combination of symptoms in individual patients varies, and in the same patient the clinical manifestations of hypoglycemia are usually stereotypical. In some cases, patients with unrecognized insulinoma are treated by a psychiatrist due to developing personality changes.

An attack of hypoglycemia may resolve itself due to the action of endogenous counterinsular mechanisms: increased release of catecholamines, cortisol, growth hormone, etc. But usually, taking easily broken down carbohydrates or intravenous administration of glucose quickly eliminates the phenomena of hypoglycemia. Patients learn from their own experience to prevent or cope with hypoglycemic attacks. Due to the need for frequent meals, patients often develop obesity.

In the most acute course of untreated hypoglycemic condition, clouded consciousness can develop into hypoglycemic coma. The introduction of glucose does not always quickly lead to the elimination of symptoms, because in patients with severe and frequent long-term hypoglycemic conditions with loss of consciousness, damage to the central nervous system, up to necrosis of parts of the brain, can develop.

Patients with insulinoma, more often with adenocarcinoma, may experience abdominal pain. The clinical picture of adenoma and adenocarcinoma is similar, although the latter is often characterized by severe hypoglycemic attacks. Long-term existence of hyperinsulinism symptoms (2 years or more) indicates 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 finishing work (physical activity), a significant improvement in the condition with the introduction of glucose allow us to suspect the presence of organic hyperinsulinism. Its proof is the detection of hypoglycemia - blood glucose 2.77 mmol/l (50 mg%) and below - and at the same time inappropriately high plasma insulin concentrations. But normal insulin levels do not exclude insulinoma; in some patients, the level of proinsulin in the blood increases.

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