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Insulinoma: Cost-effective Care in Patients with a Rare Disease

Lloyd Axelrod, MD
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Massachusetts General Hospital, Boston, MA 02114 Requests for Reprints: Lloyd Axelrod, MD, Diabetes Unit, Bulfinch 408, Massachusetts General Hospital, 32 Fruit Street, Boston, MA 02114.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1995;123(4):311-312. doi:10.7326/0003-4819-123-4-199508150-00011
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An insulinoma is the quintessential example of the elusive but curable endocrine disorder. It is a rare condition, estimated to occur four times per million person-years [1], and has nonspecific neurologic and adrenergic manifestations. It frequently eludes diagnosis for years. The neurologic manifestations, especially those that affect behavior and consciousness, are often frightening and embarrassing to those who have this condition and to those around them. An insulinoma is potentially lethal. Once identified, it is curable by surgery [1]. When an isolated benign insulinoma is removed (and most are benign), the patient has a normal life expectancy [1]. A patient with an insulinoma presents a series of challenges. The physician must recognize that the patient's symptoms are attributable to hypoglycemia, exclude other exogenous and endogenous causes of hypoglycemia, obtain appropriate hormonal studies to establish the diagnosis beyond any doubt, and guide the patient toward appropriate surgical treatment.

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