Clinical Implications of Various Criteria for the Biochemical Diagnosis of Insulinoma.
10.3803/EnM.2014.29.4.498
- Author:
Chang Ho AHN
1
;
Lee Kyung KIM
;
Jie Eun LEE
;
Chan Hyeon JUNG
;
Se Hee MIN
;
Kyong Soo PARK
;
Seong Yeon KIM
;
Young Min CHO
Author Information
1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ymchomd@snu.ac.kr
- Publication Type:Original Article
- Keywords:
Insulinoma;
Diagnostic criteria;
Insulin;
C-peptide
- MeSH:
C-Peptide;
Cohort Studies;
Diagnosis*;
Glucose;
Humans;
Hypoglycemia;
Insulin;
Insulinoma*;
Medical Records;
Retrospective Studies;
ROC Curve;
Sensitivity and Specificity
- From:Endocrinology and Metabolism
2014;29(4):498-504
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Among the various diagnostic criteria for insulinoma, the ratio criteria have been controversial. However, the amended insulin-glucose ratio exhibited excellent diagnostic performance in a recent retrospective cohort study, although it has not yet been validated in other patient cohorts. We examined the diagnostic performance of the current criteria of the Endocrine Society, insulin-glucose ratio, C-peptide-glucose ratio, and amended ratios in terms of differentiating insulinomas. METHODS: We reviewed the medical records of patients who underwent evaluation for hypoglycemia from 2000 to 2013. Fourteen patients with histopathologically confirmed insulinoma and 18 patients without clinical evidence of insulinoma were included. The results of a prolonged fast test were analyzed according to the abovementioned criteria. RESULTS: Fulfilling all three Endocrine Society criteria-plasma levels of glucose (<3.0 mmol/L), insulin (> or =8 pmol/L), and C-peptide (> or =0.2 nmol/L)-exhibited 100% sensitivity and 89% specificity. Fulfilling the glucose and C-peptide criteria showed 100% sensitivity and 83% specificity, while fulfilling the glucose and insulin criteria showed 100% sensitivity and 72% specificity. Among the ratio criteria, the insulin-glucose ratio [>24.0 (pmol/L)/(mmol/L)] gave the highest area under the receiver operating characteristic curve, with 93% sensitivity and 94% specificity. CONCLUSION: Fulfilling the glucose, insulin, and C-peptide criteria of the Endocrine Society guidelines exhibited the best diagnostic performance for insulinoma. Nonetheless, the insulin-glucose ratio may still have a role in the biochemical diagnosis of insulinoma.
