Endocrine Abstracts (2006) 11 P453

What is the best glycaemic index for the diagnostic of insulinoma?

JM Andrieu1, DB Bassiri1, RM Ramdani2, EG Guzman2, JF Fabre3, EA Aboud1 & JC Courreges1

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:

Table 1
Time7 am1 pm1 am
Glycaemia (Gly) mmol/
Insulinemia (Ins) mU/l N (2 17)
Ins/Gly N<2010.3411.212.78
Turner index N<5018.724729.2

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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