Abstract
BackgroundInsulinoma represents hypoglycemia as a predominant symptom; the autonomic symptoms may be resolved by chronically recurrent hypoglycemia resulting in the persistence of non-specific symptoms alone. Therefore, it has been estimated that there are many patients in whom the disease takes longer to diagnose and has remained undiagnosed. Although some parameters exist for the definitive diagnosis of the disease, there are currently no indices for early screening. Indices of glycemic control, hemoglobin A1c (HbA1c), and glycated albumin (GA) may be useful for the screening of patients with insulinoma having chronic hypoglycemia because the values become low in such a condition. Because there are no articles that have reported the point, we examine the effective cutoff values of HbA1c and GA for the diagnosis of insulinoma in the present study.MethodsIn a multicenter cross-sectional study, 31 patients with insulinoma were included for comparison with 120 control subjects with normal glucose tolerance based on 75 g oral glucose tolerance tests whose characteristics were matched to the patients. The primary outcomes were optimal cutoff values of HbA1c and GA for the screening of insulinoma.ResultsHbA1c was significantly lower in the insulinoma group at 4.7 ± 0.4% compared to the healthy control group at 5.7 ± 0.3% (p < 0.001), and GA was significantly lower in the insulinoma group at 11.6 ± 1.8% compared to the healthy control group at 14.5 ± 1.0% (p < 0.001). According to a receiver operating characteristic (ROC) analysis, optimal cutoff values of HbA1c and GA for the diagnosis of insulinoma were 5.0 and 12.4%, respectively. Area under the curve values of HbA1c and GA were 0.970 and 0.929, respectively, showing no significant difference (p = 0.399).ConclusionsIn the present study, HbA1c and GA values in patients with insulinoma were significantly lower compared to the healthy controls, and effective cutoff values for screening were shown in the diagnosis of insulinoma for the first time. HbA1c and GA can be useful indices for insulinoma screening. Because malignant insulinoma have a similar diagnostic process to that of benign insulinoma, these could be useful for malignant insulinoma.
Highlights
Insulinoma represents hypoglycemia as a predominant symptom; the autonomic symptoms may be resolved by chronically recurrent hypoglycemia resulting in the persistence of non-specific symptoms alone
Of the subjects in which 75 g oral glucose tolerance tests (75 g OGTT) were performed by a medical check, A total of 120 individuals with normal glucose level based on the World Health Organization criteria [8] whose characteristics [age, sex, and body mass index (BMI)] were matched to the patients above were included as a healthy control group [9]
fasting plasma glucose (FPG) was significantly lower in the insulinoma group at 51.3 ± 15.3 mg/dL compared to the healthy control group at Insulinoma group (n = 31)
Summary
Insulinoma represents hypoglycemia as a predominant symptom; the autonomic symptoms may be resolved by chronically recurrent hypoglycemia resulting in the persistence of non-specific symptoms alone. The autonomic symptoms accompanied by hypoglycemia may be resolved, and only non-specific symptoms that do not seem to be hypoglycemic manifestations persist in patients with chronically recurrent hypoglycemia [1, 2]. For such a reason, it is suggested that the diagnosis may take at least 3.6 years in over half the patients [3], and many patients are often undiagnosed [4, 5]. There are no effective early screenings in patients with persistent non-specific symptoms alone
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