Insulinoma in Patients with Diabetes- A Systematic Review of Previously Reported Cases
Introduction: Paradoxical co-existence of insulinoma and diabetes is extremely rare. Although a few case reports addressed this association, a comprehensive study elucidating this relationship has been lacking. We performed a systematic review of published cases of insulinoma in diabetes. Methods: W...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2024-12-01
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| Series: | Indian Journal of Endocrinology and Metabolism |
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| Online Access: | https://journals.lww.com/10.4103/ijem.ijem_154_24 |
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| author | Subhankar Chatterjee Rana Bhattacharjee Ritwik Ghosh Partha P. Chakraborty Anirban Sinha Animesh Maiti |
| author_facet | Subhankar Chatterjee Rana Bhattacharjee Ritwik Ghosh Partha P. Chakraborty Anirban Sinha Animesh Maiti |
| author_sort | Subhankar Chatterjee |
| collection | DOAJ |
| description | Introduction:
Paradoxical co-existence of insulinoma and diabetes is extremely rare. Although a few case reports addressed this association, a comprehensive study elucidating this relationship has been lacking. We performed a systematic review of published cases of insulinoma in diabetes.
Methods:
We conducted a literature search using PubMed and Google Scholar, employing various combinations of the following terms: ‘insulinoma’, ‘diabetes’, ‘nesidioblastosis’, ‘endogenous hyperinsulinism’, ‘hypoglycaemia’, and ‘hyperglycaemia’ (from January 1900 to January 30, 2024). Exclusion criteria included non-English publications, duplicate articles, reports lacking sufficient data, cases of endogenous hyperinsulinemic hypoglycaemia other than insulinoma, and inaccessible articles. Statistical analysis was performed using appropriate methods.
Results:
Sixty patients were considered for the final analysis. Mean age was 61 ± 15 years (range: 17–96 years) with a slight female preponderance; 88.3% had type-2 diabetes with a median duration of 8 years. The median delay in diagnosis of insulinoma was 6 months. Median blood glucose varied from 30.5 mg/dL to 235 mg/dL, with a mean HbA1c of 5.6 ± 1.3% (range: 2.9%–8.2%). Critical sampling data were available in 75% of cases. The median size of the insulinoma was 2 cm. Furthermore, 5.2% of insulinomas were extra-pancreatic. Among pancreatic insulinomas, 14.5% were multi-focal. One-third of cases were malignant. Surgical resection was done in 70.9% of cases, while 40% received drug therapy and 12.7% received both, with 20.7% overall mortality. Malignant insulinoma (P = 0.007), micro-angiopathic (P = 0.018) and macro-angiopathic complications (P = 0.039), and other co-morbidities (P = 0.009) were associated with unfavourable prognosis, while being overweight and obese (P = 0.020) at presentation was associated with favourable prognosis.
Conclusion:
This first systematic review provides insights into the uniqueness of insulinoma in diabetes. |
| format | Article |
| id | doaj-art-266d31a7e145465694c739690b4dba30 |
| institution | Kabale University |
| issn | 2230-8210 2230-9500 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Endocrinology and Metabolism |
| spelling | doaj-art-266d31a7e145465694c739690b4dba302025-01-09T12:22:14ZengWolters Kluwer Medknow PublicationsIndian Journal of Endocrinology and Metabolism2230-82102230-95002024-12-0128655456110.4103/ijem.ijem_154_24Insulinoma in Patients with Diabetes- A Systematic Review of Previously Reported CasesSubhankar ChatterjeeRana BhattacharjeeRitwik GhoshPartha P. ChakrabortyAnirban SinhaAnimesh MaitiIntroduction: Paradoxical co-existence of insulinoma and diabetes is extremely rare. Although a few case reports addressed this association, a comprehensive study elucidating this relationship has been lacking. We performed a systematic review of published cases of insulinoma in diabetes. Methods: We conducted a literature search using PubMed and Google Scholar, employing various combinations of the following terms: ‘insulinoma’, ‘diabetes’, ‘nesidioblastosis’, ‘endogenous hyperinsulinism’, ‘hypoglycaemia’, and ‘hyperglycaemia’ (from January 1900 to January 30, 2024). Exclusion criteria included non-English publications, duplicate articles, reports lacking sufficient data, cases of endogenous hyperinsulinemic hypoglycaemia other than insulinoma, and inaccessible articles. Statistical analysis was performed using appropriate methods. Results: Sixty patients were considered for the final analysis. Mean age was 61 ± 15 years (range: 17–96 years) with a slight female preponderance; 88.3% had type-2 diabetes with a median duration of 8 years. The median delay in diagnosis of insulinoma was 6 months. Median blood glucose varied from 30.5 mg/dL to 235 mg/dL, with a mean HbA1c of 5.6 ± 1.3% (range: 2.9%–8.2%). Critical sampling data were available in 75% of cases. The median size of the insulinoma was 2 cm. Furthermore, 5.2% of insulinomas were extra-pancreatic. Among pancreatic insulinomas, 14.5% were multi-focal. One-third of cases were malignant. Surgical resection was done in 70.9% of cases, while 40% received drug therapy and 12.7% received both, with 20.7% overall mortality. Malignant insulinoma (P = 0.007), micro-angiopathic (P = 0.018) and macro-angiopathic complications (P = 0.039), and other co-morbidities (P = 0.009) were associated with unfavourable prognosis, while being overweight and obese (P = 0.020) at presentation was associated with favourable prognosis. Conclusion: This first systematic review provides insights into the uniqueness of insulinoma in diabetes.https://journals.lww.com/10.4103/ijem.ijem_154_24endogenous hyperinsulinemic hypoglycaemiainsulinomanesidioblastosistype-1 diabetestype-2 diabetes |
| spellingShingle | Subhankar Chatterjee Rana Bhattacharjee Ritwik Ghosh Partha P. Chakraborty Anirban Sinha Animesh Maiti Insulinoma in Patients with Diabetes- A Systematic Review of Previously Reported Cases Indian Journal of Endocrinology and Metabolism endogenous hyperinsulinemic hypoglycaemia insulinoma nesidioblastosis type-1 diabetes type-2 diabetes |
| title | Insulinoma in Patients with Diabetes- A Systematic Review of Previously Reported Cases |
| title_full | Insulinoma in Patients with Diabetes- A Systematic Review of Previously Reported Cases |
| title_fullStr | Insulinoma in Patients with Diabetes- A Systematic Review of Previously Reported Cases |
| title_full_unstemmed | Insulinoma in Patients with Diabetes- A Systematic Review of Previously Reported Cases |
| title_short | Insulinoma in Patients with Diabetes- A Systematic Review of Previously Reported Cases |
| title_sort | insulinoma in patients with diabetes a systematic review of previously reported cases |
| topic | endogenous hyperinsulinemic hypoglycaemia insulinoma nesidioblastosis type-1 diabetes type-2 diabetes |
| url | https://journals.lww.com/10.4103/ijem.ijem_154_24 |
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