Pancreas

Insulinoma

The pancreas makes insulin, which helps keep the blood sugar level balanced. An insulinoma is a tumor of your pancreas which makes excess insulin, more than your body can use. This causes blood sugar levels to drop too low. These tumors are very rare and usually benign, meaning that they tend not spread to other parts of your body.

Insulinomas can cause hypoglycemia, or low blood sugar, because they make extra insulin. This can result in the following symptoms:

• Confusion
• Sweating
• Weakness
• Rapid heartbeat

Patients with insulinoma often notice that they feel much better when they eat or drink something, especially sugary foods or drinks.  They may find themselves eating very frequently or even waking up in the middle of the night to eat.  Over time, this can lead to significant weight gain.

How are insulinomas diagnosed?
Insulinomas can be difficult to diagnose. The average time between the start of symptoms and establishing a diagnosis is about 3 years.

If your doctor suspects an insulinoma, you may be admitted to the hospital for a test called a supervised fast.. This is so your doctor can watch your blood sugar and other substances in your blood while you fast. You will not be able to eat or drink anything except water during this time. If you have an insulinoma, you will probably have very low blood sugar levels within 48 hours of starting this test.

Your health care provider may also use imaging tests. These can help find out how big your tumor is and where it's located. A CT (computed tomography) scan may be used to locate insulinomas. Or, your health care provider may use an endoscopic ultrasound. This is an outpatient procedure that uses a tiny ultrasound probe to create an image of your pancreas.

How are insulinomas treated?
Most insulinomas are not cancerous. Surgeons can usually remove them and cure the condition. Often, surgery can be performed laparoscopically, using a fiberoptic camera and specialized instruments inserted into the abdomen (belly) through small (band-aid sized) incisions.

Gastrinoma (Zollinger-Ellison Syndrome)

Zollinger-Ellison syndrome (ZES) is a rare digestive disorder. ZES is caused by a tumor growing in the pancreas or small intestine.  These tumors, called gastrinomas, release the hormone gastrin. This causes the stomach to release too much acid. Stomach acid is needed to break down food. But, too much acid can cause painful peptic ulcers inside the lining of your stomach and intestine. Gastrinoma tumors cause significant health problems and may sometimes be cancerous.

How is Zollinger-Ellison syndrome diagnosed?
If you have the symptoms associated with ulcers or ZES, your health care provider may measure your stomach acid levels. He or she may also give you a blood test to measure your level of the hormone gastrin, to see whether your body makes too much. Your health care provider may order imaging tests, such as a CT scan or endoscopic ultrasound to look for tumors.

How is Zollinger-Ellison syndrome treated?
Acid-reducing drugs, called proton pump inhibitors, can help manage the extra stomach acid. These drugs help to stop ulcers from developing. They include esomeprazole, lansoprazole, and omeprazole.

In many cases, surgery is needed to remove tumors in your digestive tract. In the most severe cases, including when tumors have spread to others parts of your body, your doctor may give you chemotherapy to destroy them.

Multiple Endocrine Neoplasia, Type 1

Patients with multiple endocrine neoplasia, type 1 (MEN-1), a rare genetic syndrome, can develop tumors of the pancreas.  These tumors may or may not secrete excess hormones, such as insulin and gastrin (described above).

Read more about genetic syndromes.

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