In the setting of bariatric surgery, can see nesidioblastosis - large islet cell population that doesn't apoptose after surgery
Most insulinomas associated with significant weight gain
If insulinoma suspected:
- Need to check glucose at the same time as C-peptide and insulin level
- Glucose needs to be below certain threshold (~50 mg/dL) to suggest hyperinsulinism
- Should also check sulfonylurea screen
Ideally, insulinomas should be visualized with cross-sectional imaging, either CT or MRI
- If not possible, can use EUS/ERCP (from which one can also biopsy) or octreotide scan, although the latter have relatively high false negative rate
Treatment of insulinoma? Octreotide or diazoxide, although diazoxide not ideal for long term management due to side effects of edema and hirsutism
Posted 06/08/17 01:03:09 PM by Iheanacho (Obi) Emeruwa
Created by Christopher Kelly
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