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Insulinoma: Hypoglycemia - Coggle Diagram

- - - - history
      - PE findings
      - results of other testing
  - - - Multiple small meals (36/day) high in protein and complex carbohydrates may control signs prior to surgery
      - IV dextrose 5-10% may be needed to control symptomatic hypoglycemia in some, even when eating normally
      - Fast 8-12 hours and keep on IV dextrose overnight
      - Explore and carefully evaluate the pancreas for nodules
      - Nodules tend to be small (1-2.5 cm diameter)
      - 45% have metastases visible at surgery in regional nodes or the liver Post-operative course
      - Complications following surgery include:
        
        Persistent hypoglycemia ( incomplete)
        
        Traumatic pancreatitis (uncommon) Persistent Hypoglycemia
        
        Occurs if the primary tumor is inoperable or metastases are present
        
        Paradoxical diabetes mellitus (atrophied other beta cells)
        
        Proposed that prolonged hypoglycemia down regulates normal islets which are slow to respond to rising glucose post-operatively
        
        Partial pancreatectomy decreases islet reserve
        
        Usually transient from a few days to several months
        
        A few require chronic insulin therapy
        
        Gradual growth of previously undetected metastases will result in resolution of the diabetes in nearly all if they survive long enough
        
        Eventually they will become symptomatic for hypoglycemia again
        
        Signs of insulin overdosage and insulinoma are identical!