Insulinoma

Insulinomas are the most common sporadic endocrine tumour of the pancreas.

Epidemiology

Account for 40% of syndromic pancreatic endocrine tumours. Overall incidence of ~0.0003%.

Clinical presentation

Typically insulinomas present with Whipple's triad consisting of:

  1. fasting hypoglycemia (<50 mg/dl)
  2. symptoms of hypoglycemia (due to subsequent catecholamine release)
  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 develop from ductal pluripotent cells into unregulated cells secreting insulin. The beta cells of the islets of Langerhans normally secrete insulin. 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 (90% are <2 cm at presentation 3) and hypervascular. They may contain calcifications. Malignant tumours tend to be larger. Equally distributed between head, body, and tail of the pancreas.

CT

They tend to be hyperattenuating on arterial phase so arterial or pancreatic phase imaging may aid in better detection 6-7. Some may show calcification.

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
Nuclear medicine

Unlike other pancreatic endocrine tumors, insulinomas do not tend to express somatostatin analogs and somatostatin receptor scintigraphy is not generally useful for localisation.


Pancreatic pathology
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Article Information

rID: 12908
Section: Pathology
Synonyms or Alternate Spellings:
  • Insulinomas
  • Pancreatic insulinoma
  • Pancreatic insulinomas
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    Case 3: metastatic insulinoma 
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    Arterial phase: a...
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