Insulinoma natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]

Overview

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.

Natural History, Complications, and Prognosis

Natural History

Complications

Prognosis

  • 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]

References

  1. "Natural History of Untreated Insulinoma over a Course of 7 Years : Endocrine Neoplasia: Tumorigenesis and Therapeutics".
  2. Graves TD, Gandhi S, Smith SJ, Sisodiya SM, Conway GS (2004). "Misdiagnosis of seizures: insulinoma presenting as adult-onset seizure disorder". J Neurol Neurosurg Psychiatry. 75 (8): 1091–2. doi:10.1136/jnnp.2003.029249. PMC 1739168. PMID 15258206.
  3. Service FJ, McMahon MM, O'Brien PC, Ballard DJ (1991). "Functioning insulinoma--incidence, recurrence, and long-term survival of patients: a 60-year study". Mayo Clin Proc. 66 (7): 711–9. PMID 1677058.
  4. Hirshberg B, Cochran C, Skarulis MC, Libutti SK, Alexander HR, Wood BJ; et al. (2005). "Malignant insulinoma: spectrum of unusual clinical features". Cancer. 104 (2): 264–72. doi:10.1002/cncr.21179. PMC 4136659. PMID 15937909.


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