Endocrine- Insulinoma and Hypoglycemia

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Endocrine- Insulinoma and Hypoglycemia
2015-09-23 22:23:52
vetmed endocrinology

vetmed endocrinology
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  1. Insulinoma is an ___________; is it a ________ tumor that causes symptomatic _________.
    islet cell carcinoma; malignant; hypoglycemia
  2. Why is early diagnosis so important with insulinoma?
    it is malignant but slow to metastasize; early treatment greatly increases survival time
  3. What is Whipple's Triad of hyperinsulinism?
    neurologic signs, hypoglycemia, and resolution of clinical signs after glucose administration
  4. What is the signalment for patients with insulinoma?
    none... it can happy to any dog!!! very unusual in cats, common in ferrets
  5. What are the 3 most common clinical signs of insulinoma? What are they a result of?
    seizures, weakness, collapse; result from glucose deprivation of the brain
  6. The physical exam of an insulinoma patient...
    is usually normal.
  7. What is the first clue that you're dealing with insulinoma, found on CBC?
    hypoglycemia BG<60mg/dL, fast 6-12 hrs to document hypoglycemia
  8. What is a key feature of diagnosing insulinoma?
    high or normal blood insulin and low blood glucose (if blood glucose is low in a normal patient, insulin should be nearly zero)
  9. What imaging is used to see insulinoma? What is not?
    radiographs CANNOT show insulinoma, US can see tumors bigger than 2 cm (NEG DOESNT RULE IT OUT)
  10. What is the ideal treatment for insulinoma?
    surgery if caught early enough; always check for mets first, not worth it if metastasized
  11. During surgery to remove insulinoma, always...
    check local lymph nodes and liver to remove identifiable metastatic lesions.
  12. Describe palliative treatment for insulinoma.
    frequent feedings, limited exercise, glucocorticoids (to antagonize insulin)
  13. Drug that inhibits insulin secretion and stimulates glycogen lysis and gluconeogenesis; expensive and hard to find.
  14. Somatostatin analogue that transiently inhibits insulin synthesis and secretion.
  15. What are 3 post-op complications of insulinoma surgery?
    pancreatitis (very common), transient DM (normal beta cells were suppressed by cancer cells, need to recover), persistent hypoglycemia (did not remove all tumor masses)
  16. What is the prognosis associated with insulinoma?
    not curable, can be managed for months to years; ultimately, mets emerge and recurrent hypoglycemia occurs
  17. __________ are the most common insulinomas in ferrets; treatment is _________.
    Carcinomas; palliative
  18. Non-beta cell tumor-associated hypoglycemia may cause impaired _________ from ________; also, IGF-1 may be increased with __(2)__.
    glucose release; liver glycogen; leiomyoma, GI stromal tumors
  19. Diagnosis of non-beta cell tumor-associated hypoglycemia involves __________ with _________; treatment includes... (2)
    hypoglycemia; low serum insulin; supportive, tumor removal
  20. What is the most common form of juvenile hypoglycemia, and what causes it?
    transient idiopathic juvenile hypoglycemia; puppies (esp. toy breeds) with stress, hypothermia, starvation, parasites
  21. What is the treatment for transient idiopathic juvenile hypoglycemia?
    use common sense: warmth, glucose, treat parasites; will usually resolve with supportive care
  22. Von Gierke's disease is _________; clinical signs include... (4)
    Type Ia glycogen storage disease; hypoglycemia w/ clinical signs, hepatomegaly, renomegaly, failure to respond to glucagon
  23. Von Gierke's disease patients don't respond to glucagon because they have a ___________ deficiency.
  24. Some other random causes of hypoglycemia. (6)
    hunting dog hypoglycemia, liver disease, hypoadrenocorticism, sepsis, Xylitol in dogs, insulin overdose
  25. BG decreases _________ as blood stands in a clot tube at room temperature.