Table 3.
Comprehensive review of clinical presentations, laboratory diagnostics, radiological insights, and therapeutic interventions for insulinoma during pregnancy.
| Patient | Year | Age (years) | Symptom onset | Blood sugar (mmol/L) | Insulin (pmol/L) | C-peptide (nmol/L) | Pro-insulin | Radiological findings | Management |
|---|---|---|---|---|---|---|---|---|---|
| 1 [8] | 1977 | 21 | Gestation: 1st trimester |
2 | 1861.1 | N/A | N/A | Splenic angio: 2 cm tumor in pancreatic body. During pregnancy. | Laparotomy. Gestation: week 12. |
| 2 [9] | 1983 | 33 | Gestation: week 7 | 1.5 | 208.3–277.8 | N/A | 0.2 pmol/ml | US, CT: 2 cm tumor in pancreatic head. Both during pregnancy. | Laparotomy. Gestation: week 17. |
| 3 [10] | 1984 | 19 | Gestation: 1st trimester |
1.7 | 399.3 | 0.33 | N/A | CT, angio: 1.8 × 2.6 cm2 tumor in pancreatic tail. Both during pregnancy. | Laparotomy post-pregnancy termination. 1st trimester. |
| 4 [11] | 1985 | 24 | Gestation: week 10 | 1.2 | 201.4 | 1.19 | 0.1 U/ml | CT: no evidence of tumor. Angio: tumor in pancreatic body. Both post-delivery. | Laparotomy. Post-delivery. |
| 5 [12] | 1986 | 24 | Gestation: week 6 | 0.6 | 1006.9 | 0.77 | N/A | US, CT, angio: no evidence of tumor. All post-delivery. | Laparotomy. Post-delivery |
| 6 [13] | 1988 | 37 | Gestation: week 35 | 1.1 | 631.9 | N/A | N/A | US: no evidence of tumor. During pregnancy. | Liver examination during caesarean section showed multiple nodules of malignant insulinoma (died post-surgery day 10 due to progressive hepatic failure). |
| 7 [14] | 1988 | 41 | Gestation: 1st trimester |
1.9 | 437.5 | N/A | N/A | CT, angio: no evidence of tumor. Both post-delivery. | Laparotomy. Post-delivery. |
| 8 [15] | 1990 | 26 | Gestation: week 16 | 1 | 104.2 | 2.28 | N/A | CT, angio: 2-cm tumor in pancreatic tail. Both post-delivery. | Laparotomy. Post-delivery. |
| 9 [16] | 1991 | 25 | Gestation: 1st trimester |
1.9 | 368.1 | 0.02 | N/A | US: no evidence of tumor. During pregnancy. | Laparotomy. 1st trimester. |
| 10 [17] | 1992 | 30 | Gestation: week 16 | 0.7 | 184 | N/A | N/A | – | Autopsy (died 2 weeks post-delivery due to severe sepsis). |
| 11 [18] | 1992 | 24 | Gestation: 1st trimester |
1.3 | 54 | N/A | N/A | US: no evidence of tumor. MRI: tumor in pancreatic tail. Both during pregnancy. | Exploratory laparotomy with resection of distal pancreas (2nd trimester). A 2nd laparotomy with tumor resection post-delivery. |
| 12 [19] | 1994 | 26 | Gestation: week 16 | 1.7 | 493.1 | 3 | N/A | CT: 1-cm tumor in pancreatic tail. Post-delivery. | Laparotomy. Post-delivery. |
| 13 [20] | 1994 | 25 | Gestation: week 6 | 1.9 | 187.5 | N/A | N/A | US, EUS: no evidence of tumor. Both during pregnancy. | Laparotomy. Gestation: week 17. |
| 14 [21] | 2001 | 36 | Postpartum: day 1 | 1.2 | N/A | N/A | N/A | CT: 1.5-cm tumor in pancreatic head. Post-delivery. | Laparotomy. Post-delivery. |
| 15 [22] | 2002 | 26 | Gestation: week 6 | 1.3 | 909.7 | 0.03 | N/A | MRI, CT: tumor in pancreatic tail. Both post-delivery. | Laparotomy. Post-delivery. |
| 16 [23] | 2002 | 35 | Postpartum: week 3 | 2.1 | 104.2 | 2 | N/A | US, CT, intraarterial calcium stimulation: no evidence of tumor. All post-delivery. | Laparotomy. Post-delivery. |
| 17 [24] | 2008 | 35 | Postpartum: month 3 | 1.5 | 178.5 | 0.89 | N/A | CT, angiography: no evidence of tumor. Both post-delivery. | Laparotomy. Post-delivery. |
| 18 [24] | 2008 | 35 | Postpartum: day 26 | 1.9 | 47.2 | 0.29 | N/A | CT, EUS, intraarterial calcium stimulation: no evidence of tumor. All post-delivery. | Laparoscopy. Post-delivery. |
| 19 [24] | 2008 | 22 | Gestation: month 2 | 2.3 | 477.1 | N/A | N/A | MRI: 2.5-cm cystic tumor in pancreatic tail. EUS: 1.2 × 2 cm2 cystic tumor and 1.7 × 1.5 cm2 solid hypoechoic lesion. Both post-delivery. | Laparoscopy. Post-delivery. |
| 20 [25] | 2008 | 29 | Gestation: week 35 | 0.9 | 51 | 0.76 | 45 pmol/l | US, CT, MRI, somatostatin receptor scintigraphy: no evidence of tumor. Intraoperative US: 5-mm tumor in pancreatic head. All post-delivery. | Laparotomy. Post-delivery. |
| 21 [26] | 2008 | 26 | Postpartum: day 3 | 1.3 | 38.9 | 0.35 | 16 pmol/l | MRI: 1.2-cm tumor in pancreatic head. Post-delivery. | Laparotomy. Post-delivery. |
| 22 [28] | 2012 | 29 | Gestation: week 17 | 1.6 | N/A | N/A | N/A | US: innumerable hypoechoic liver lesions. MRI: innumerable T2-hyperintense lesions throughout liver. Both during pregnancy. | Therapy with everolimus. Post-delivery. |
| 23 [29] | 2012 | 21 | Postpartum: day 8 | 2.1 | 54 | N/A | N/A | CT: 2-cm tumor in pancreatic head. Post-delivery. | Laparoscopic enucleation of tumor. Post-delivery. |
| 24 [30] | 2015 | 38 | Postpartum: week 3 | 1.5 | 67.4 | 0.52 | N/A | US: no evidence of tumor. EUS: hypoechoic lesion (8 × 9 mm2) in pancreatic head. Both post-delivery. | Laparotomy. Post-delivery |
| 25 [31] | 2017 | 36 | Gestation: week 17 | 2.7 | 29.5 | 0.54 | 7.49 U/ml | EUS: 1.8 × 2.2 cm2 tumor in pancreatic tail. MRI: 2-cm hyperintense solid lesion in pancreatic tail. Both during pregnancy. | Laparotomy in 2nd trimester. Gestation: week 21. |
| 26 [32] | 2020 | 34 | Postpartum: day 2 | 2 | 300 | 1.62 | N/A | US: no evidence of tumor. MRI: 10 × 8 mm2 lesion in pancreatic head. EUS: 14.3 mm lesion in pancreatic head. All post-delivery. | Laparotomy. Post-delivery. |
| 27 Our case |
2020 | 30 | Gestation: week 13 | 1.4 | 79.2 | 0.51 | N/A | MRI: 2.0 × 1.6 cm2 tumor in pancreatic body. During pregnancy. | Robotic-assisted pancreatic enucleation. Gestation: week 18. |
Angio, angiography; CT, computed tomography; EUS, endoscopic ultrasound; MRI, magnetic resonance imaging; N/A, not available; US, ultrasound.