Insulinoma natural history, complications and prognosis

If left untreated, patients with insulinoma may progress to develop seizures, coma and even death. Prognosis is generally excellent for benign insulinoma after the removal of the tumor. Recurrence rates are higher in those associated with MEN1 syndrome.

• The symptoms of insulinoma are found in any age group and start with neuroglycopenic symptoms such as altered mental status, visual disturbances, confusion and adrenergic symptoms such as profuse sweating, palpitations and tremors.
• If left untreated, hypoglycemic episodes progresses in frequency, although the tumor size remains small. ^[1]

• Common complications of insulinoma are due to hypoglycemia include:^[2]
  • Seizures
  • Coma
  • Death

• 90% insulinomas are benign and they are generally cured after the removal of the tumor, so benign insulinoma is associated with the most favorable prognosis. ^[3]
• The prognosis varies with the malignant potential of the tumor; grade 1 and 2 tumor have the most favorable prognosis.
• Malignant insulinomas: In a study of 10 patients, the first 4 who presented with lymph node metastasis after surgical excision, maintained a prolonged tumor-free survival. The next four patients presented with metastasis to the liver, which appeared years after the initial diagnosis and presumed curative surgery. One patient presented with a large α-fetoprotein-secreting liver mass. Finally, 9 of the 10 patients had a prolonged survival.^[4]

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