Continuous glucose monitoring in patients with insulinoma.
BACKGROUND
Insulinomas are rare neuroendocrine tumours that are usually small and may take time to localize. They cause recurrent life-threatening spontaneous hypoglycaemia. Recurrent hypoglycaemia causes loss of hypoglycaemia awareness, putting the patient at further risk, but this has rarely been described in insulinoma. We describe the utility of continuous glucose monitoring (CGM) in patients with insulinoma.


METHODS
Three patients, aged 72 years (patient 1), 37 years (patient 2) and 24 years (patient 3), with suspected insulinoma attended our investigation unit, in a university teaching hospital. Biochemical diagnosis was confirmed by elevated plasma insulin and C-peptide during biochemical hypoglycaemia [plasma glucose < 2.2 mM (40 mg/dl)]. Surgery confirmed histology in all. CGM was used to monitor frequency and time of hypoglycaemia during diagnosis and medical treatment, and after definitive surgical treatment.


RESULTS
All patients had evidence of hypoglycaemia unawareness. At diagnosis in patients 1-3, CGM revealed 6.1%, 21.9% and 71.0% of time spent in moderate hypoglycaemia (plasma glucose 2.2-3.0 mM), and 1.4%, 11.4% and 48.1% of time in severe hypoglycaemia (plasma glucose < 2.2 mM), respectively. On diazoxide this reduced to 0.6%, 5.4% and 5.7% time in moderate hypoglycaemia, and no severe hypoglycaemia in patients 1 and 3, and 0.5% in patient 2. Octreotide therapy in patients 2 and 3 resulted in 5.8% and 0% of time in moderate hypoglycaemia, respectively, and no severe hypoglycaemia. After surgical excision CGM confirmed cure in all.


CONCLUSIONS
CGM in insulinoma is useful in detecting hypoglycaemia, and hypoglycaemia unawareness, monitoring response to medical therapy and for confirming cure postoperatively, and is useful in the management of this uncommon but dangerous condition.
Munir
Alia
A
Academic Unit of Diabetes, Endocrinology and Metabolism, Sheffield University, Royal Hallamshire Hospital, Sheffield, UK.
Choudhary
Pratik
P
Harrison
Barney
B
Heller
Simon
S
Newell-Price
John
J
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001786:Blood Glucose / Q000032:analysis*; D003981:Diazoxide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy; D007340:Insulinoma / Q000378:metabolism*; D008297:Male; D015282:Octreotide / Q000627:therapeutic use; D055815:Young Adult
D000959:Antihypertensive Agents; D018931:Antineoplastic Agents, Hormonal; D001786:Blood Glucose; D003981:Diazoxide; D015282:Octreotide