INSULINOMA

DEFINISI
• Tumor pulau Langerhans pada sel beta, biasanya jinak, yang men-sekresikan insulin dan
merupakan salah satu penyebab utama hipoglikemia. (Kamus Kedokteran Dorland)

• Insulinomas are the most common cause of hypoglycemia resulting from endogenous
hyperinsulinism
• Insulinomas are generally small (>90% are <2 cm)
• and usually not multiple (90%)
• only 5–15% are malignant
• they almost invariably occur only in the pancreas
• distributed equally in the pancreatic head, body, and tail.
 EPIDEMIOLOGY
• Insulinomas are the most common pancreatic endocrine tumors
• The incidence is 3-10 cases per million people per year
• These make up 55% of neuroendocrine tumors
• The average age of occurrence is 40–50 years old
 ETIOLOGY
• Penyebabnya tidak diketahui, tetapi resiko terjadinya insulinoma meningkat pada penderita
neoplasia endokrin multipel

• There is a history suggesting that attacks are provoked by fasting, or with a family history of
MEN 1.
 GEJALA KLINIS
• Gejala-gejalanya disebabkan oleh rendahnya kadar gula dalam darah
• Biasanya timbul saat pasien sedang ber puasa

• Diplopia • Abnormal behavior

• Blurred vision • Unconsciousness
• Palpitations • Adrenergic symptoms (from hypoglycemia-related
adrenalin release): Weakness, sweating, tachycardia,
• Weakness palpitations, and hunger
• Confusion • Seizures
 DIAGNOSIS
• Whipple triad:
• Presence of symptoms of hypoglycemia (about 85% of patients)
• Documented low blood sugar at the time of symptoms
• Reversal of symptoms by glucose administration
1. Anamnesis
2. Px. Fisik
3. Px. Penunjang
• Tes biokimia
• Imaging
• Endosonografi
• Ultrasonografi
• CT scan
• Angiography
• MRI
• SRS (somatostatin receptor scintigraphy)
 BIOKIM
• Serum insulin levels of 10 µU/mL or more (normal < 6 µU/mL)
• Glucose levels of less than 40 mg/dL
• C-peptide levels exceeding 2.5 ng/mL (normal < 2 ng/mL)
• Proinsulin levels greater than 25% (or up to 90%) of immunoreactive insulin levels
• Screening for sulfonylurea negative
HISTOPATOLOGI
CT-SCAN
MRI
ENDOSONOGRAFI
ANGIOGRAPHY
 TATALAKSANA
• Non-Farmakologi: Pembedahan

• Farmakologi:
• Diazoxide (150-800 mg/d)
• Hydrochlorothiazide: Counteracts edema and hyperkalemia secondary to diazoxide and
potentiates its hyperglycemic effect
• Somatostatin analogs (octreotide, lanreotide): Prevent hypoglycemia
• Everolimus: For patients with metastatic insulinoma and refractory hypoglycemia
 REFERENSI
• Harrisson’s Internal Medicine ed.19th
• NCBI Insulinoma Diagnosis and Management