Insulinoma

This diagnosis relates to an insulin secreting tumour of the pancreas. This section also covers the investigation of spontaneous hypoglycaemia of any cause.

General examination

To diagnose insulinoma a detailed and full general examination is mandatory in the initial assessment of all patients.

Volume status should be carefully assessed in patients with diarrhoea.

Blood pressure and cardiovascular examination

Thorough cardiovascular examination is mandatory in patients presenting with possible collapses.

Cardiac arrhythmia, cardiomyopathy and signs of cardiac failure, postural blood pressure and blood pressure in both arms should all be assessed looking for alternative causes of attacks.

Blood pressure is typically high in patients with phaeochromocytoma and low in patients with glucocorticoid deficiency.

Neck and lymph nodes

Palpable lymph nodes are suggestive of metastatic disease. Detailed neck examination is required to seek evidence of parathyroid masses.

Carotid bruits may be present in cerebrovascular disease. Thymic hyperplasia is rarely palpable.

Eyes

Corneal calcification may be apparent with long standing hypercalcaemia.

Abdomen

Examine for pancreatic or bowel associated masses and hepatomegaly.

Urinalysis

Seeking evidence of renal disease due to hypercalcaemia.

Skin

Facial angiofibromas, collagenomas and lipomas may be associated with insulinomas in MEN1.

Pituitary status

Pituitary status and visual fields should be examined in all patients with possible MEN1.

Neurological examination

Full assessment of the neurological system is mandatory in case of alternative underlying causes of the patient's symptoms.

Thyroid status

Specifically seek signs of thyrotoxicosis as this might mimic the symptoms of insulinoma.