Paroxysmal Hypertension Induced by an Insulinoma.

Published on Feb 15, 2017in Internal Medicine1.005
· DOI :10.2169/INTERNALMEDICINE.56.7758
Ko Harada3
Estimated H-index: 3
(Okayama University),
Yoshihisa Hanayama6
Estimated H-index: 6
(Okayama University)
+ 4 AuthorsFumio Otsuka35
Estimated H-index: 35
(Okayama University)
: Insulinoma is a rare, usually benign, pancreatic neuroendocrine tumor. The clinical features of an insulinoma are fasting hypoglycemia with neuroglycopenic symptoms including confusion and unusual behavior, while hypertension is usually not associated with the disease. We herein report a patient with insulinoma who manifested paroxysmal hypertension and neuroglycopenic symptoms. The possible etiology of hypertension induced by an insulinoma is catecholamine release in response to hypoglycemia, which may cause acute hypertension through activation of the sympatho-adrenal system. This case implies that sustained hyperinsulinemia due to insulinoma can be functionally linked to the induction of paroxysmal hypertension.
#1Tetsuro Tsujimoto (Jichi Medical University)H-Index: 17
Last. Mitsuhiko NodaH-Index: 62
view all 9 authors...
Objective To assess vital signs, QT intervals, and newly diagnosed cardiovascular disease during severe hypoglycemia in diabetic patients. Research Design and Methods From January 2006 to March 2012, we conducted a retrospective cohort study to assess type 1 and type 2 diabetic patients with severe hypoglycemia at a national center in Japan. Severe hypoglycemia was defined as the presence of any hypoglycemic symptoms that could not be resolved by the patients themselves in prehospital settings. ...
71 CitationsSource
Insulin has long been hypothesized to cause sodium retention, potentially of enough magnitude to contribute to hypertension in obesity, metabolic syndrome, and Type II diabetes. There is an abundance of supportive evidence from correlational analyses in humans, acute insulin infusion studies in humans and animals, and chronic insulin infusion studies in rats. However, the absence of hypertension in human insulinoma patients, and negative results for sodium-retaining or blood pressure effects of ...
36 CitationsSource
#1Wallace Johnson (UMB: University of Maryland, Baltimore)H-Index: 6
#2My Le Nguyen (UMB: University of Maryland, Baltimore)H-Index: 1
Last. Ronak Y. Patel (UMB: University of Maryland, Baltimore)H-Index: 18
view all 3 authors...
An elevated blood pressure (BP) reading in the emergency department should be confirmed in more than one anatomic location based on JNC 7 guidelines and reassessed multiple times before and during therapy. Patients with severely (>180/120 mm Hg) or moderately (140–179/90–119 mm Hg) elevated BP suspected of having end-organ damage should undergo appropriate testing to determine if they have hypertensive urgency versus emergency. Absolute BP cutoffs are not as important as the presence or absence ...
32 CitationsSource
#1B. Kaul (AIIMS: All India Institute of Medical Sciences)H-Index: 1
#2P. Kaur (AIIMS: All India Institute of Medical Sciences)H-Index: 1
Last. S. Dattagupta (AIIMS: All India Institute of Medical Sciences)H-Index: 1
view all 8 authors...
A 10-year-old girl, who was referred with refractory epilepsy, had 1.5 years of episodic abnormal behavior. On examination, she also had hypertension and peripheral neuropathy. Hypoglycemia with correspondingly high insulin levels was documented during a confusional episode. MRI of the abdomen revealed an islet cell tumor in the body of the pancreas. One year after tumor excision, both the neuropathy and hypertension showed remarkable improvement. A final diagnosis of insulinoma with hypoglycemi...
2 CitationsSource
#1David S. Klimstra (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 145
#2Irvin R. ModlinH-Index: 2
Last. Saul SusterH-Index: 82
view all 5 authors...
Neuroendocrine tumors (NETs) arise in most organs of the body and share many common pathologic features. However, a variety of different organ-specific systems have been developed for nomenclature, grading, and staging of NETs, causing much confusion. This review examines issues in the pathologic assessment of NETs that are common among primaries of different sites. The various systems of nomenclature are compared along with new proposal for grading and staging NETs. Although differences persist...
1,166 CitationsSource
#1Kimberly A. Placzkowski (Mayo Clinic)H-Index: 2
#2Adrian VellaH-Index: 60
Last. Ricardo V. Lloyd (Mayo Clinic)H-Index: 94
view all 8 authors...
Objective: The objective of the study was to assess changes in the presentation and diagnostic and radiological evaluation of patients with surgically confirmed insulinoma at the Mayo Clinic 1987–2007. Methods: A retrospective analysis of patients with insulinoma was conducted. Patients with prior gastric bypass were excluded. Results: A total of 237 patients [135 women (57%)] were identified. Hypoglycemia was reported solely in the fasting state in 73%, the fasting and postprandial state in 21%...
274 CitationsSource
#1Thorvardur R. Halfdanarson (Mayo Clinic)H-Index: 28
#2Joseph Rubin (Mayo Clinic)H-Index: 70
Last. Gloria M. PetersenH-Index: 121
view all 5 authors...
Pancreatic neuroendocrine tumors or pancreatic endocrine tumors (PETs) are uncommon neoplasms with incidence lower than 1 per 100,000 persons per year in population studies.(Buchanan, et al. 1986; Carriaga and Henson 1995; Eriksson, et al. 1989; Halfdanarson, et al. 2007; Lam and Lo 1997; Moldow and Connelly 1968; Watson, et al. 1989) The incidence is higher in autopsy studies, ranging from 0.8% to 10% suggesting that these tumors frequently go unnoticed.(Grimelius, et al. 1975; Kimura, et al. 1...
347 CitationsSource
Insulin resistance is proposed to be causally related to the metabolic syndrome disorders, but a direct cause-and-effect relationship between insulin resistance and hypertension was not originally obv
96 CitationsSource
These cells lie together generally in considerablenumbers scattered diffusely in the parenchyma ofthe gland…. I must refrain from making anyhypothesis as to the nature and significance of our cells.PAUL LANGERHANS, 1869 25 Typically measuring only 1 to 2 cm in diameter and concealed within the normal pancreatic parenchyma, insulinomas frequently cause bizarre symptoms that may remain undiagnosed for years, even leading to serious mental deterioration. Simple excision completely and entirely reso...
62 CitationsSource
#1Steven M. Haffner (University of Texas Health Science Center at San Antonio)H-Index: 149
#2H. MiettinenH-Index: 30
Last. Michael P. SternH-Index: 29
view all 4 authors...
Background: The relation of possible metabolic precursors (especially insulin resistance) to hypertension has been controversial. In addition, these associations may differ by level of obesity or ethnicity. Methods: We followed up 1039 initially nondiabetic, nonhypertensive subjects from the San Antonio Heart Study for 7 years. Results: Hypertension developed in 93 subjects. Age, body mass index, waist-to-hip ratio, and fasting insulin and triglyceride levels predicted the development of hyperte...
114 CitationsSource
Cited By0