Gold standard test for insulinoma:
Correct Answer: 72 hours fasting test
Description: Ans. a. 72 hours fasting test 818; Blumgari 5/e p935-937. Shackelford 7fepi206-/210)Gold standard test for the diagnosis of insulinoma is the 72-hour fasting test."Gold standard test for the diagnosis of insulinoma is the 72-hour fastinge test. An insulin-to-glucose ratio >0.4 is consistent with insulinomaInsulinoma* Insulinoma is MC functioning tumor of the endocrine pancreas* The average age at diagnosis is 45 years.Location of Insulinoma* 97% in pancreas (equal distribution in the head, body, and tail)0* 3% in duodenum, splenic hilum, or gastrocolic ligament0.* Typically small, with an average size of 1.0 to 1.5 cm.Diagnostic hallmark is Whipple's triad: Symptoms of hypoglycemia + Low blood glucose levels (40-50 mg/dL) +Relief of symptoms after the administration of glucose.Clinical Features:Diagnostic hallmark is Whipple's triad0: Fasting-induced neuroglyopenic symptoms of hypoglycemia (diaphoresis, shaking, mental confusion, obtundation, and seizures), low blood glucose levels (40 to 50 mg/dL), and relief of symptoms after the administration of glucose.Sympathetic overactivity0 in response to hypoglycemia: Fatigue, weakness, fearfulness, hunger, tremor, diaphoresis, and tachycardia.CNS disturbance: Apathy, irritability, anxiety, confusion, excitement, loss of orientation, blurred vision, delirium, stupor, coma, and'or seizures.Significant weight gain: Patients eat frequently to prevent hypoglycemia.* it's a painless condition.Diagnosis:* Gold standard test for the diagnosis of insulinoma is the 72-hour fasting0 test.* An insulin-to-glucose ratio >0.4 is consistent w ith insulinoma0.* Provocative testing with tolbutamide, glucagon: or intravenous calcium is rarely required.CECT or MR1: Hyperattenuating as compared w ith surrounding pancreatic tissue because of rich vascular supplyLocalization:* Angiography will detect approximately 70% of insulinomas >5 mm, showing a characteristic vascular blush0Portal venous sampling for insulin with or without arterial stimulation with calcium is the best pre-operative method of localization0.* ELS with intra-operative palpation is best localization technique for Insulinoma0.Treatment:* Diazoxide decreases beta cell release of insulin, used to prevent or attenuate symptoms of hypoglycemia prior to surgical interv ention once the diagnosis is made0.* Insulinomas are well suited for laparoscopic resection or enucleations0.Insulinoma of head of pancreas* Enucleation is TOCdegInsulinoma of body or tail of pancreas* Distal pancreatectomy is TOCdeg
Category:
Surgery
Get More
Subject Mock Tests
Practice with over 200,000 questions from various medical subjects and improve your knowledge.
Attempt a mock test nowMock Exam
Take an exam with 100 random questions selected from all subjects to test your knowledge.
Coming SoonGet More
Subject Mock Tests
Try practicing mock tests with over 200,000 questions from various medical subjects.
Attempt a mock test now