Causes and risk factors
Insulin is a hormone which is produced by the islets of Langerhans cells of the pancreas. It controls the sugar levels in the blood and transfers the glucose, which is used for production of energy from blood to the body cells. After each meal, the blood sugar levels rises. The islets of Langerhans cells produces insulin, this insulin brings back the raised levels of glucose to normal levels. Due to formation of tumor in the islets of Langerhans cells, there occurs continuous production of insulin. As a result, the blood sugar levels drop down continuously. The exact cause of formation of tumor in insulinoma is not known. The only fact known is that presence of a rare familial syndrome like multiple endocrine neoplasia and von Hippel-Lindau syndrome increases the risk factor for production of insulinoma.
Clinical presentation:
Various systems of the body are affected leading to a variety of complaints. The tumor formed is a benign tumor, rarely can it be cancerous. In most of the cases, single tumor formation is seen; however, multiple formation of tumors have also been reported in a few cases. In most of the cases, the tumor formed is less than 2 cm. An individual suffering from insulinoma commonly presents with hypoglycemia complaining of headache, blurred vision, weakness, and easy fatigue. The person tends to become forgetful and confused; there is a feeling of sickness and hunger. Diarrhea, pain in the back, and palpitation are other symptoms seen. Certain tumors do not produce hormones at the initial stage. The extra production of insulin is seen when the size of the tumor goes on increasing. Affection of the adrenal gland and brain can also occur. This can lead to a variety of severe complaints like epilepsy and seizures.
Investigations:
Diagnosis is made on the basis of symptoms narrated by the patient and the examination carried out by the doctor. Certain investigations which can be advised are routine blood tests along with blood sugar levels. Specialized tests like C-peptide levels and insulin levels are also done. On palpation, the abdomen is tender to touch. Endoscopic ultrasonography is done. CT scan and MRI of the abdomen can also be done. Glucose tolerance test is another test. Clinically, insulinoma is diagnosed by Whipple triad. It comprises of complaints of low sugar levels at the time of symptoms and the complaints are reverted back to normal on glucose administration.
Treatment:
The treatment plan comprises of administration of medications which will inhibit the release of insulin from the tumor. Medications for preventing hypoglycemia are given. Along with this, surgical excision of the tumor needs to be done. Single tumor needs to be excised. Laparoscopic surgery is the most favorable method of choice. In cases of multiple tumors, partial pancreatectomy is done.. However, removal of pancreas induces diabetes mellitus. In such cases, insulin injections are started. For malignant tumors, along with surgical excision of the tumor, radiation and chemotherapy is started.
Other Modes of treatment:
Certain other modes of treatment can also be helpful in coping up the symptom. Taking into consideration the symptoms in a holistic way, homoeopathy can offer a good aid for the relief of the symptoms. The Ayurvedic system of medicine which uses herbs and synthetic derivates can also be beneficial in combating the complaints. Certain yoga exercises can also be helpful in strengthening the muscles.
Facts and Figures:
The incidence of insulinoma is 1 to 3 people in every 1 million people each year.
