Management of insuloma patients with refractory hypoglycemia

Insulinomas in dogs have been described frequently. The clinical signs of this tumor result from neuroglycopenia and increased concentrations of plasma catecholamines. Laboratory confirmation of hypoglycemia in association with an inappropriately high serum insulin concentration helps establish a tentative diagnosis of insulinoma. Surgical exploration of the pancreas and histologic evaluation is required for definitive diagnosis of insulinoma. Whenever possible, surgical excision of the primary lesion and associated metastases should be performed. The distinction between benign and malignant insulinomas is based on the presence or absence of metastases and clinical course of disease. Histologically, it is difficult to determine the malignant potential of these tumors. Careful medical management is essential to the dog with signs referable to an insulinoma, whether the patient is awaiting surgery, is not a surgical candidate, or has a relapse of signs after surgical resection. This chapter will review the clinical and diagnostic features of insulinoma in dogs and address the problem of refractory hypoglycemia and its management.