Insulinoma???

[dizzfire]

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So in the free 150 there was a question about a previously health 32 yr old with a 3 wk hx of dizziness, nasusea, sweating that resolves with eating. no other abnorm no smoking, four glasses of wine/wk. she gets another episode at the hospital her labs are: gluc 35, c peptide 0.5, insulin 20, cortisol 10, urine sulfonylurea negative. Where is the tumor located?

So the answer was pancreas but why would you have a low C peptide and an elevated insulin in an insulinoma? I thought if produced by the body that they rise with each other?

Thanks All

 

[whoknows2012]

So in the free 150 there was a question about a previously health 32 yr old with a 3 wk hx of dizziness, nasusea, sweating that resolves with eating. no other abnorm no smoking, four glasses of wine/wk. she gets another episode at the hospital her labs are: gluc 35, c peptide 0.5, insulin 20, cortisol 10, urine sulfonylurea negative. Where is the tumor located?

So the answer was pancreas but why would you have a low C peptide and an elevated insulin in an insulinoma? I thought if produced by the body that they rise with each other?

Thanks All

They do which is why I'm a little confused with this question too. I mean for me would have just chosen pancreas anyway as you did since nothing else makes sense.

 

[mastamark]

So in the free 150 there was a question about a previously health 32 yr old with a 3 wk hx of dizziness, nasusea, sweating that resolves with eating. no other abnorm no smoking, four glasses of wine/wk. she gets another episode at the hospital her labs are: gluc 35, c peptide 0.5, insulin 20, cortisol 10, urine sulfonylurea negative. Where is the tumor located?

So the answer was pancreas but why would you have a low C peptide and an elevated insulin in an insulinoma? I thought if produced by the body that they rise with each other?

Thanks All

Was liver a choice? I wonder if she was alcoholic, had hepatitis b/c, or any other cause of hepatic failure.

 

[dizzfire]

So you're saying liver failure is causing a decrease in gluconeo, which is why the glucose is low. I can see that. However, it states that she was previously healthy, and the problem began 3 weeks ago, i guess fulminant hep is possible, however i feel she would also have many other symptoms as well and given the hx there is no clear exposure to Hep B and i would say its unlikely that 4 glasses of wine a week will lead to fulminant hep. Also, the answer was def. pancreas, chose it and got it right, but just wondering whats up with that C Pep

 

[SeekerOfTheTree]

So in the free 150 there was a question about a previously health 32 yr old with a 3 wk hx of dizziness, nasusea, sweating that resolves with eating. no other abnorm no smoking, four glasses of wine/wk. she gets another episode at the hospital her labs are: gluc 35, c peptide 0.5, insulin 20, cortisol 10, urine sulfonylurea negative. Where is the tumor located?

So the answer was pancreas but why would you have a low C peptide and an elevated insulin in an insulinoma? I thought if produced by the body that they rise with each other?

Thanks All

She had normal insulin levels to. They are a little on the high end but still within normal bounds for what they gave as the normal range. I think the question writers just messed up on this one.

 

[mastamark]

So you're saying liver failure is causing a decrease in gluconeo, which is why the glucose is low. I can see that. However, it states that she was previously healthy, and the problem began 3 weeks ago, i guess fulminant hep is possible, however i feel she would also have many other symptoms as well and given the hx there is no clear exposure to Hep B and i would say its unlikely that 4 glasses of wine a week will lead to fulminant hep. Also, the answer was def. pancreas, chose it and got it right, but just wondering whats up with that C Pep

oooh gotcha. I misread your question. Yeah, doesn't make sense.

 

[mastamark]

So in the free 150 there was a question about a previously health 32 yr old with a 3 wk hx of dizziness, nasusea, sweating that resolves with eating. no other abnorm no smoking, four glasses of wine/wk. she gets another episode at the hospital her labs are: gluc 35, c peptide 0.5, insulin 20, cortisol 10, urine sulfonylurea negative. Where is the tumor located?

So the answer was pancreas but why would you have a low C peptide and an elevated insulin in an insulinoma? I thought if produced by the body that they rise with each other?

Thanks All

I guess it could be somatostatinoma. Somatostatin will decrease gluconeogenesis in liver by dropping GH. It will also lower C-Peptide by supressing insulin, it will also inhibit glucagon. It's rare but I guess it's possible yeah? If that's it, it's a pretty hard question.

 

[whoknows2012]

I guess it could be somatostatinoma. Somatostatin will decrease gluconeogenesis in liver by dropping GH. It will also lower C-Peptide by supressing insulin, it will also inhibit glucagon. It's rare but I guess it's possible yeah? If that's it, it's a pretty hard question.

I think you might be thinking too much into this. How could there be a blood glucose of 35 then? If the person is eating a normal diet then reduced gluconeogenesis wouldn't be the cause of a 65 point decrease in blood glucose levels...