hypoglycemia & the omas

Question 1

what does C-peptide measure?

Answer 1

fragment of endogenously produced proinsulin that is split from proinsulin as insulin is formed

Question 2

when is the only time that C-peptide levels can increase?

Answer 2

if endogenous insulin production is increased

Question 3

what is insulinoma

Answer 3

rare usually benign pancreatic islet cell tumors

Question 4

what is the most common cause of hypoglycemia d/t endogenous hyperinsulinism?

Answer 4

insulinoma

Question 5

size of tumors in insulinoma

Answer 5

small and can be numerous

Question 6

With which type of MEN is insulinoma common?

Answer 6

MEN 1

Question 7

which condition has highly variable presentation and have fasting or exercise precipitating the sx?

Answer 7

insulinoma

Question 8

what are sx of insulinoma?

Answer 8

anxiety
confusion
behavior changes
clouded vision
dizziness
HA
hunger
LOC
sweating

Question 9

expected insulin, glucose & c-peptide levels with insulinomas

Answer 9

low glucose with high insulin & c-peptide

Question 10

what do you need for biochemical diagnosis of insulinoma?

Answer 10

insulin 10+, glucose <40, c-peptide >3.5
proinsulin >25% to 90% of immunoreactive insulin
no SUs

Question 11

which condition requires prolonged fasting (up to 72hrs) for labs?

Answer 11

insulinoma

Question 12

which imaging can be done to diagnose insulinomas?

Answer 12

CT scan or US after confirmatory labs to localize!

Question 13

how are insulinomas treated?

Answer 13

surgical resection

Question 14

another name for gastrinoma

Answer 14

zolligner-ellison syndrom

Question 15

what is zollinger-ellison syndrome?

Answer 15

gastrinomas derived from multipotent stem cells

Question 16

where do gastrinomas typically originate?

Answer 16

pancreas and small intestine

Question 17

what is the typical age range where you’d see a gastrinoma

Answer 17

20-50yo

Question 18

are gastrinomas benign or malignant?

Answer 18

majority are malignant that metastasize to nodes and liver

Question 19

three symptoms of gastrinomas

Answer 19

abdominal pain
diarrhea
hematemesis

Question 20

in which two patient populations should you suspect gastrinomas?

Answer 20

patients with refractory hyperacidic disease
patients with multiple duodenal cancers