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Clinical Presentation of Insulinomas

المؤلف:  Wass, J. A. H., Arlt, W., & Semple, R. K. (Eds.).

المصدر:  Oxford Textbook of Endocrinology and Diabetes

الجزء والصفحة:  3rd edition , p1007-1008

2026-08-29

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 Hypoglycaemia is the hallmark of an insulinoma. Patients usually present with non- specific, episodic hypoglycaemic symptoms, which fall into two categories: neuroglycopaenic or autonomic (adrenergic/ neurogenic). Neuroglycopaenia occurs when plasma glucose levels fall below 2.2 mmol/ L and is due to glucose deprivation in the central nervous system. These symptoms include dizziness, confusion, fatigue, difficulty in speaking or concentrating, headache, changes in vision, seizures, and loss of consciousness. Autonomic symptoms caused by sympathoadrenal activation con sist of sweating, hunger, paraesthesiae, tremor, anxiety, palpitations, and nausea. All these symptoms usually resolve with the ingestion of carbohydrate or injection of glucose. Most patients with insulinomas are exclusively symptomatic in the fasting state (73%), some in the post- prandial period (6%), or both (21%). They may accommodate by eating regular, high- sugar snacks, exacerbating weight gain (although the hyperinsulinaemia may also con tribute to this). Diagnosis is often delayed due to the non- specific presentation.