Gold standard test for insulinoma:

Ans. a. 72 hours fasting test 818; Blumgari 5/e p935-937. Shackelford 7fepi206-/210)Gold standard test for the diagnosis of insulinoma is the 72-hour fasting test."Gold standard test for the diagnosis of insulinoma is the 72-hour fastinge test. An insulin-to-glucose ratio >0.4 is consistent with insulinomaInsulinoma* Insulinoma is MC functioning tumor of the endocrine pancreas* The average age at diagnosis is 45 years.Location of Insulinoma* 97% in pancreas (equal distribution in the head, body, and tail)0* 3% in duodenum, splenic hilum, or gastrocolic ligament0.* Typically small, with an average size of 1.0 to 1.5 cm.Diagnostic hallmark is Whipple's triad: Symptoms of hypoglycemia + Low blood glucose levels (40-50 mg/dL) +Relief of symptoms after the administration of glucose.Clinical Features:Diagnostic hallmark is Whipple's triad0: Fasting-induced neuroglyopenic symptoms of hypoglycemia (diaphoresis, shaking, mental confusion, obtundation, and seizures), low blood glucose levels (40 to 50 mg/dL), and relief of symptoms after the administration of glucose.Sympathetic overactivity0 in response to hypoglycemia: Fatigue, weakness, fearfulness, hunger, tremor, diaphoresis, and tachycardia.CNS disturbance: Apathy, irritability, anxiety, confusion, excitement, loss of orientation, blurred vision, delirium, stupor, coma, and'or seizures.Significant weight gain: Patients eat frequently to prevent hypoglycemia.* it's a painless condition.Diagnosis:* Gold standard test for the diagnosis of insulinoma is the 72-hour fasting0 test.* An insulin-to-glucose ratio >0.4 is consistent w ith insulinoma0.* Provocative testing with tolbutamide, glucagon: or intravenous calcium is rarely required.CECT or MR1: Hyperattenuating as compared w ith surrounding pancreatic tissue because of rich vascular supplyLocalization:* Angiography will detect approximately 70% of insulinomas >5 mm, showing a characteristic vascular blush0Portal venous sampling for insulin with or without arterial stimulation with calcium is the best pre-operative method of localization0.* ELS with intra-operative palpation is best localization technique for Insulinoma0.Treatment:* Diazoxide decreases beta cell release of insulin, used to prevent or attenuate symptoms of hypoglycemia prior to surgical interv ention once the diagnosis is made0.* Insulinomas are well suited for laparoscopic resection or enucleations0.Insulinoma of head of pancreas* Enucleation is TOCdegInsulinoma of body or tail of pancreas* Distal pancreatectomy is TOCdeg