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Insulinoma

Dr Ian Bickle and Dr Frank Gaillard et al.

Insulinomas are the most common endocrine tumours of the pancreas.

Clinical presentation

Typically insulinomas present with Whipple's triad consisting of:

  1. fasting hypoglycemia
  2. symptoms of hypoglycemia
  3. immediate relief of symptoms after the administration of IV glucose

As with other endocrine tumours of the pancreas, there is an association with multiple endocrine neoplasia type I (MEN I). 

Pathology

They fall under islet cell tumours of the pancreas. Approximately 10% of insulinomas are multiple and 10% malignant.

Radiographic features

These tumours can be relatively small and multiphase contrast enhanced thin slice cross-sectional imaging is ideal.  Most insulinomas are small (2/3rds less than 2cm at presentation 3) and hyper-vascular. Some contain calcification. Malignant tumours tend to be large.

CT

Arterial or pancreatic phased imaging may aid in better detection 6-7.

MRI

Dynamic MRI with fast gradient echo sequences following bolus injection of contrast medium may aid the detection of these tumours 4. 

  • T1 C+ (Gd) : typically shows enhancement, although contrast enhancement may not improve tumour visualisation compared with non-contrast images 4.
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