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Related Concept Videos

Insulin: Dosing Regimen and Adverse Effects01:16

Insulin: Dosing Regimen and Adverse Effects

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Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
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Glucose Homeostasis: Pancreatic Islets and Insulin Secretion01:27

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The pancreatic islets comprising only 1%-2% of the volume are highly vascularized and innervated mini-organs. They contain five endocrine cell types, including β cells that secrete insulin, which is synthesized as a single polypeptide chain, preproinsulin, processed to proinsulin, and finally to insulin and C-peptide. This process is complex and regulated, involving the Golgi complex, the endoplasmic reticulum, and the secretory granules of the β cell.
Insulin and C-peptide are...
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Diabetes Mellitus: Overview and Type I Subtype01:22

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Diabetes mellitus is a chronic metabolic disorder characterized by high blood glucose levels due to inadequate insulin production, insulin resistance, or both. The condition affects millions worldwide and can significantly impact their health and quality of life.
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Insulin Secretory Vesicles01:05

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Insulin secretory vesicles release insulin to stimulate blood glucose uptake and regulate carbohydrate metabolism. When the blood glucose levels increase, glucose enters the pancreatic β-islet cells through glucose transporters. Once inside, glucose is metabolized through glycolysis, the citric acid cycle, and the electron transport chain, producing ATP. This increase in ATP concentration closes ATP-sensitive potassium channels, leading to depolarization of the membrane and the opening of...
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Hypoglycemia and Glucagon01:15

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Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
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Robotic Enucleation of an Intra-Pancreatic Insulinoma in the Pancreatic Head
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Ectopic insulinoma: case report.

Mengqing Sun1, Yaping Luo2, Yan You3

  • 1Department of General Surgery, Peking Union Medical College Hospital, Beijing, China.

BMC Surgery
|December 20, 2019
PubMed
Summary
This summary is machine-generated.

Ectopic insulinomas, rare tumors causing hypoglycemia, are challenging to locate preoperatively. Advanced imaging like 68Ga-Exendin-4 PET/CT aids diagnosis, with surgical removal being the primary treatment for symptom relief.

Keywords:
68Ga-Exendin-4 PET/CTEctopic insulinomaHypoglycemia

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Area of Science:

  • Endocrinology
  • Oncology
  • Diagnostic Imaging

Background:

  • Ectopic insulinoma, a rare cause of hyperinsulinemic hypoglycemia, presents diagnostic challenges due to its non-pancreatic location.
  • The Whipple triad (hypoglycemia symptoms, low blood glucose, symptom relief after glucose administration) is characteristic.

Observation:

  • Two patients presented with recurrent hypoglycemia and a positive Whipple triad.
  • Standard preoperative imaging failed to localize the insulinoma in both cases.
  • Advanced imaging techniques, including CT, MRI, somatostatin receptor imaging, SPECT/CT, and 68Ga-Exendin-4 PET/CT, successfully identified ectopic tumor locations.

Findings:

  • 68Ga-Exendin-4 PET/CT demonstrated high diagnostic value in locating the ectopic insulinoma.
  • Postoperative pathology confirmed neuroendocrine tumors in both surgically removed lesions.
  • Surgical resection led to complete resolution of hypoglycemia and normalization of blood glucose levels.

Implications:

  • Ectopic insulinoma diagnosis requires advanced imaging beyond standard pancreatic evaluation.
  • 68Ga-Exendin-4 PET/CT is a valuable tool for precise localization of these rare tumors.
  • Surgical intervention remains the definitive treatment for ectopic insulinoma, effectively managing hyperinsulinemic hypoglycemia.