Insulinoma

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.

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.

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.

Corneal calcification may be apparent with long standing hypercalcaemia.

Examine for pancreatic or bowel associated masses and hepatomegaly.

Seeking evidence of renal disease due to hypercalcaemia.

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

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

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

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