Whipple's triad in insulinoma include all EXCEPT
(A) ACTH is treatment of choice # Features of Insulinoma:> Insulinomas are solitary benign rare neuroendocrine tumours with an incidence estimated at 1 to 4 new cases per million persons per year.> Insulinoma is one of the most common types of tumour arising from the islets of Langerhans cells (pancreatic endocrine tumours).> Estimates of malignancy (metastases) range from 5% to 30%. Over 99% of insulinomas originate in the pancreas, with rare cases from ectopic pancreatic tissue.> About 5% of cases are associated with tumours of the parathyroid glands and the pituitary (Multiple endocrine neoplasia type 1) and are more likely to be multiple and malignant.> Most insulinomas are small, less than 2 cm.# Signs & Symptoms> Patients with insulinomas usualiy develop neuroglycopenic symptoms.> These include recurrent headache, lethargy, diplopia, and blurred vision, particularly with exercise or fasting. Severe hypoglycemia may result in seizures, coma, and permanent neurological damage.> Symptoms resulting from the catecholaminergic response to hypoglycemia (i.e. tremulousness, palpitations, tachycardia, sweating, hunger, anxiety, nausea) are not as common. Sudden weight gain (the patient can become massively obese) is sometimes seen.
ACTH is treatment of choice
Symptoms relieved by glucose
Hypoglycemia below 45 mg%
An attack of hypoglycemic in the fasting stage
Miscellaneous