Download PDF
Exp Clin Endocrinol Diabetes 2010; 118(1): 9-18
DOI: 10.1055/s-0029-1202272
Mini-Review

© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Insulinoma in Pregnancy

B. Besemer 1 , K. Müssig 1
  • 1Divison of Endocrinology, Diabetology, Nephrology, Angiology, and Clinical Chemistry, Department of Internal Medicine, University Hospital of Tübingen, Tübingen, Germany
Further Information

Publication History

received 15.08.2008 first decision 23.10.2008

accepted 22.01.2009

Publication Date:
16 April 2009 (online)

Also available at
    Permissions and Reprints

Abstract

Insulinomas are rare, mostly benign neuroendocrine tumours with an incidence of approximately four cases per million person per year. Only isolated case reports of insulinomas occurring in pregnancy have been documented. Clinical signs and symptoms of insulinoma appear to be attenuated and, in some cases, even masked by pregnancy. Therefore, in the present overview of insulinomas occurring during pregnancy, special attention is paid to potential factors contributing to the altered insulin response during pregnancy.

Key words

neuroendocrine tumour - hypoglycaemia - insulin resistance - insulin-antagonistic action - gestation

References

  • 1 Akanji AO, George AO, Olasode BJ. et al . Insulinoma in pregnancy presenting as a seizure disorder: A case report.  E Afr Med J. 1992;  69 117-119
    PubMedGoogle Scholar
  • 2 Anderson MA, Carpenter S, Thompson NW. et al . Endoscopic ultrasound is highly accurate and directs management in patients with neuroendocrine tumors of the pancreas.  Am J Gastroenterol. 2000;  95 2271-2277
    CrossrefPubMedGoogle Scholar
  • 3 Atala C, Tapia M. Insulinoma in pregnancy.  Rev Chil Obstet Ginecol. 1992;  57 437-439
    PubMedGoogle Scholar
  • 4 Auinger M, Dudczak R, Fasching W. et al . Diagnosis of an insulinoma during pregnancy – A rare cause of hypoglycemia.  Wien Klin Wochenschr. 1994;  106 426-429
    PubMedGoogle Scholar
  • 5 Bardet S, Mahot P, Deumier B. et al . Discovery of an insulinoma during the first trimester of pregnancy.  Presse Med. 1994;  23 285-287
    PubMedGoogle Scholar
  • 6 Beck P, Daughaday WH. Human placental lactogen: studies of its acute metabolic effects and disposition in normal man.  J Clin Invest. 1967;  46 103-110
    PubMedGoogle Scholar
  • 7 Brändle M, Pfammatter T, Spinas GA. et al . Assessment of selective arterial calcium stimulation and hepatic venous sampling to localize insulin-secreting tumours.  Clin Endocrinol (Oxf). 2001;  55 357-362
    CrossrefPubMedGoogle Scholar
  • 8 Campbell WR, Graham RR, Robinson WL. Islet cell tumors of the pancreas.  Am J Med Sci. 1939;  198 445-454
    PubMedGoogle Scholar
  • 9 Catalano PM, Tyzbir ED, Roman NM. et al . Longitudinal changes in insulin release and insulin resistance in nonobese pregnant women.  Am J Obstet Gynecol. 1991;  165 1667-1672
    CrossrefPubMedGoogle Scholar
  • 10 Catalano PM, Tyzbir ED, Wolfe RR. et al . Longitudinal changes in basal hepatic glucose production and suppression during insulin infusion in normal pregnant women.  Am J Obstet Gynecol. 1992;  167 913-919
    CrossrefPubMedGoogle Scholar
  • 11 Catalano P, Highman T, Huston L. et al . Relationship between reproductive hormones/TNF-alpha and longitudinal changes in insulin sensitivity during gestation.  Diabetes. 1996;  45 ((suppl 2)) 175a
    PubMedGoogle Scholar
  • 12 Christiansen E, Vestergaard H. Insulinoma in a third-trimester pregnant woman combined with pre-eclampsia: a case report and review of the diagnostic strategies.  Gynecol Endocrinol. 2008;  24 417-422
    CrossrefPubMedGoogle Scholar
  • 13 Costrini NV, Kalkhoff RK. Relative effects of pregnancy, estradiol, and progesterone on plasma insulin and pancreatic islet insulin secretion.  J Clin Invest. 1971;  50 992-999
    PubMedGoogle Scholar
  • 14 Herder WW de, Niederle B, Scoazec JY. et al . Well-differentiated pancreatic tumor/carcinoma: insulinoma.  Neuroendocrinology. 2006;  84 183-188
    CrossrefPubMedGoogle Scholar
  • 15 Diaz AG, Herrera J, Lopez M. et al . Insulinoma associated with pregnancy.  Fertil Steril. 2008;  90 199, , e1–e4
    PubMedGoogle Scholar
  • 16 Egley CC, Gutliph J, Bowes Jr WA. Severe hypoglycemia associated with HELLP syndrome.  Am J Obstet Gynecol. 1985;  152 576-577
    PubMedGoogle Scholar
  • 17 Fredericks B, Entsch G, Lepre F. et al . Pregnancy ameliorates symptoms of insulinoma – a case report.  Aust N Z J Obstet Gynaecol. 2002;  42 564
    CrossrefPubMedGoogle Scholar
  • 18 Friedman E, Moses B, Engelberg S. et al . Malignant insulinoma with hepatic failure complicating pregnancy.  South Med J. 1988;  81 86-88
    PubMedGoogle Scholar
  • 19 Galun E, Ben-Yehuda A, Berlatzki J. et al . Insulinoma complicating pregnancy: A case report and review of the literature.  Am J Obstet Gynecol. 1986;  155 64-65
    PubMedGoogle Scholar
  • 20 Garner PR, Tsang R. Insulinoma complicating pregnancy presenting with hypoglycemic coma after delivery: A case report and review of the literature.  Obstet Gynecol. 1989;  73 847-849
    PubMedGoogle Scholar
  • 21 Gouya H, Vignaux O, Augui J. et al . CT, endoscopic sonography, and a combined protocol for preoperative evaluation of pancreatic insulinomas.  AJR Am J Roentgenol. 2003;  181 987-992
    PubMedGoogle Scholar
  • 22 Hale PJ, Hale JF, Nattrass M. Insulinoma and pregnancy. Case report.  Br J Obstet Gynaecol. 1988;  95 514-517
    PubMedGoogle Scholar
  • 23 Hiramoto JS, Feldstein VA, LaBerge JM. et al . Intraoperative ultrasound and preoperative localization detects all occult insulinomas.  Arch Surg. 2001;  136 1020-1025
    PubMedGoogle Scholar
  • 24 Kirwan JP, Hauguel-De Mouzon S, Lepercq J. et al . TNF-alpha is a predictor of insulin resistance in human pregnancy.  Diabetes. 2002;  51 2207-2213
    CrossrefPubMedGoogle Scholar
  • 25 Krenning EP, Bakker WH, Breeman WA. et al . Localisation of endocrine-related tumours with radioiodinated analogue of somatostatin.  Lancet. 1989;  1 242-244
    PubMedGoogle Scholar
  • 26 Liberman CG, DeLosAngeles Valenzuela MR, Hernandez FF. et al . Insulinoma and pregnancy: Case report.  Rev Med Chile. 1991;  119 564-566
    PubMedGoogle Scholar
  • 27 Lo CY, Chan FL, Tam SC. et al . Value of intra-arterial calcium stimulated venous sampling for regionalization of pancreatic insulinomas.  Surgery. 2000;  128 903-909
    CrossrefPubMedGoogle Scholar
  • 28 Lowy AJ, Chisholm DJ. Insulinoma masked by pregnancy.  Intern Med J. 2001;  31 128-129
    CrossrefPubMedGoogle Scholar
  • 29 Müssig K, Pereira PL, Horger M. et al . Symptom-masking of a insulinoma by pregnancy.  Diabetologie und Stoffwechsel. 2006;  1 261-267
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Müssig K, Bares R, Duziak K. et al . Multimodal imaging of pancreatic neuroendocrine tumors.  Rofo. 2008;  180 373-379
    PubMedGoogle Scholar
  • 31 Müssig K, Wehrmann M, Horger M. Insulinoma in pregnancy.  Fertil Steril. 2009;  91 656
    CrossrefPubMedGoogle Scholar
  • 32 Notterman RB, Jovanovic L, Peterson R. et al . Spontaneous hypoglycemic seizures in pregnancy. A manifestation of panhypopituitarism.  Arch Intern Med. 1984;  144 189-191
    CrossrefPubMedGoogle Scholar
  • 33 Osei K, Kramer DS, Malarkey WB. et al . Pregnancy complicated by insulinoma.  Am J Med Sci. 1984;  288 133-135
    CrossrefPubMedGoogle Scholar
  • 34 Owen NJ, Sohaib SA, Peppercorn PD. et al . MRI of pancreatic neuroendocrine tumours.  Br J Radiol. 2001;  74 968-973
    PubMedGoogle Scholar
  • 35 Pereira PL, Roche AJ, Maier GW. et al . Insulinoma and islet cell hyperplasia: value of the calcium intraarterial stimulation test when findings of other preoperative studies are negative.  Radiology. 1998;  206 703-709
    CrossrefPubMedGoogle Scholar
  • 36 Persson B, Hansson U. Hypoglycaemia in pregnancy.  Baillieres Clin Endocrinol Metab. 1993;  7 731-739
    CrossrefPubMedGoogle Scholar
  • 37 Pompen AW, Jansen CAL, Dhont J. Adenoma of the islets of Langerhans and pregnancy.  Acta Med Scand. 1946;  124 334-347
    PubMedGoogle Scholar
  • 38 Reid RL, Quigley ME, Yen SS. Pituitary apoplexy. A review.  Arch Neurol. 1985;  42 712-719
    PubMedGoogle Scholar
  • 39 Rubens R, Carlier A, Thiery M. et al . Pregnancy complicated by insulinoma.  Br J Obstet Gynaecol. 1977;  84 543-547
    PubMedGoogle Scholar
  • 40 Serrano-Rios M, Cifuentes I, Prieto JC. et al . Insulinoma in a pregnant woman.  Obstet Gynecol. 1976;  47 361-364
    PubMedGoogle Scholar
  • 41 Service FJ, MacMahon MM, O’Brien PC. et al . Functioning insulinoma-incidence, recurrence, and long-term survival of patients: a 60-year study.  Mayo Clin Proc. 1991;  66 711-719
    CrossrefPubMedGoogle Scholar
  • 42 Shaw DL, Bernene JL, Williams JW. et al . Insulinoma in pregnancy.  Ariz Med. 1985;  42 406-408
    PubMedGoogle Scholar
  • 43 Sivan E, Boden G. Free fatty acids, insulin resistance, and pregnancy.  Curr Diab Rep. 2003;  3 319-322
    CrossrefPubMedGoogle Scholar
  • 44 Smallridge RC, Corrigan DF, Thomason AM. et al . Hypoglycemia in pregnancy. Occurrence due to adrenocorticotropic hormone and growth hormone deficiency.  Arch Intern Med. 1980;  140 564-565
    CrossrefPubMedGoogle Scholar
  • 45 Smythe AR, MacFarland KF, Yousufuddin M. et al . Multiple endocrine adenomatosis type I in pregnancy.  Am J Obstet Gynecol. 1990;  163 1037-1039
    PubMedGoogle Scholar
  • 46 Takacs CA, Krivak TC, Napolitano PG. Insulinoma in pregnancy: a case report and review of the literature.  Obstet Gynecol Surv. 2002;  57 229-235
    CrossrefPubMedGoogle Scholar
  • 47 Usta IM, Barton JR, Amon EA. et al . Acute fatty liver of pregnancy: an experience in the diagnosis and management of fourteen cases.  Am J Obstet Gynecol. 1994;  171 1342-1347
    PubMedGoogle Scholar
  • 48 Whipple AO. The surgical therapy of hyperinsulinism.  J Int Chir. 1938;  3 273-276
    PubMedGoogle Scholar
  • 49 White NJ, Warrell DA, Chanthavanich P. et al . Severe hypoglycemia and hyperinsulinemia in falciparum malaria.  N Engl J Med. 1983;  309 61-66
    PubMedGoogle Scholar
  • 50 Wilson JD, Hugh TB. Pregnancy complicated by an insulinoma.  Aust NZ J Obstet Gynaecol. 1983;  23 176-179
    PubMedGoogle Scholar

Correspondence

Dr. K. MüssigMD 

Medizinische Klinik IV

Universitätsklinikum Tübingen

Otfried-Müller-Str. 10

72076 Tübingen

Germany

Phone: +49/0/7071/29 836 70

Fax: +49/0/7071/29 27 84

Email: Karsten.Muessig@med.uni-tuebingen.de

      >