In patients with suspected hypoglycemia, low plasma glucose concentrations must be documented at the time of symptoms, as symptoms alone may be nonspecific. Symptoms can be divided into either adrenergic (anxiety, sweating, palpitations) or neuroglycopenic (headache, dizziness, confusion), the latter being more specific for true organic hypoglycemia. Hypoglycemic symptoms tend to occur with plasma glucose concentrations at or below 50mg/dl with CNS disturbances becoming apparent below 45mg/dl. Clinical hypoglycemic disorders have been divided into two broad categories: those occurring in seemingly healthy patients and those occurring in patients who are obviously ill. The diagnosis of endogenous hyperinsulinism is dependent on the satisfaction of Whipple’s triad. The triad includes neuroglycopenia, documented hypoglycemia (plasma glucose levels <50mg/dl), and symptoms relieved (often within 5–10min) with the administration of glucose.
The incidence of insulinomas is ~4 per one-million persons per year. Well over 90% are benign and solitary, and most are less than 2 cm in diameter. Women outnumber men ~3:2. They are equally distributed throughout the pancreas. Ten percent occur within the context of the multiple endocrine neoplasia type I (MEN I) syndrome, and in this setting may be multiple, in association with parathyroid hyperplasia, and occasionally pituitary neoplasia (i.e., prolactinomas).
KeywordsDistal Pancreatectomy Multiple Endocrine Neoplasia Type Parathyroid Hyperplasia Splenic Preservation Ketotic Hypoglycemia
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