ECE2006 Poster Presentations Endocrine tumours and neoplasia (116 abstracts)
What is the best glycaemic index for the diagnostic of insulinoma?
JM Andrieu 1 , DB Bassiri 1 , RM Ramdani 2 , EG Guzman 2 , JF Fabre 3 , EA Aboud 1 & JC Courreges 1
1General Hospital, Narbonne, France; 2General Hospital, Beziers, France; 3University Hospital, Montpellier, France.
We present the observation of a patient in whom the diagnostic of insulinoma was difficult in front of normality on the classically used indexes. A 63-year-old patient, whithout any antecedent or drug used, was admitted in our service after a hypoglycaemic coma (glycaemia 1.21 mmol/l, insulinemia not measured). Clinical examination was normal. We performed a fasting testing. Results are listed in this table:
| Time | 7 am | 1 pm | 1 am |
| Glycaemia (Gly) mmol/ | 2.9 | 2.1 | 2.50 |
| Insulinemia (Ins) mU/l N (2 17) | 4.12 | 3.29 | 4.38 |
| Ins/Gly N<20 | 10.34 | 11.2 | 12.78 |
| Turner index N<50 | 18.72 | 47 | 29.2 |
Glycaemia indexes were normal, as well as the initial interpretation of abdominal scan, but, the diagnosis of insulinoma was suspected. So we performed an echo endoscopy which shows a mass of one centimeter in the pancreatic isthmus. Transgastric ponction of this mass shows a neuro-endocrine proliferation cells compatible with an insulinoma. In spite of a treatment by octreotide, hypoglycaemias was frequent and sever. The patient was sent to a surgeon who practiced a enucleo-resection with immediate result on hypoglycaemias. Insulinoma was confirmed by the anathomo-pathologist. The interest of this well-known observation is in one hand to discuss the validity of glycaemia indexes. With the new technics who detect only insulinemia and not pro-insulinemi, they are inadequat and should be left. With the new technics any insulinemia superior to 2 mU/ml concomitant of a glycaemia under 2.2 mmol/l allows the diagnostic. In the other hand to show the interest of transgastric biopsy during echo-endoscopy when evaluating pancreatic mass. Finally the enucleo-resection with coeliscopy wich reduces the morbidity.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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