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Issue 15 - What's new this week & insulinomas

Issue 15 - What's new this week & insulinomas
By Pulsenotes • Issue #15 • View online
Evening team!
Welcome to the 15th instalment of our weekly dose!
Happy Sunday - hopefully everyone has found some time to enjoy the weather this week!
A short one this week, I will let you know what’s new @pulsenotes and Norton is back with more medical morsels.
Enjoy our ‘weekly dose’? - Remember to tell your friends about us!

What's new this week?
LIVE webinars - what we’ve got coming up…
Our summer series of FREE LIVE WEBINARS continues with two more lectures!
Take shelter from next week’s mix of heatwaves and thunderstorms and join us for some important medical and surgical topics. Sam will be here to take you through Colorectal cancer whilst Norton will be covering Heart failure.
  1. Tuesday 11th August 10:00 am BST - Pulsenotes LIVE: Colorectal cancer.
  2. Sunday 16th August 10:00 am BST - Pulsenotes LIVE: Heart failure.
Remember - recordings of all these LIVE events will be available for members that aren’t able to make it!
More new stuff…
We’ve just uploaded recordings of last weeks LIVE events for you to watch at your leisure! These include:
Our medical library continues to grow with the publication of a number of new notes:
And it doesn’t stop there. We have added new Urology and Rheumatology questions - so log on and start testing yourself!
Norton's Corner
An insulinoma refers to a tumour of the beta cells within the Islets of Langerhan of the pancreas. It is a favourite medical school topic to assess in written examinations.
Insulinomas are normally benign tumours (rarely malignant) that cause an excessive secretion of insulin. This leads to recurrent fasting hypoglycaemia due to an inappropriately high level of insulin for the blood glucose concentration. Insulinomas may occur de novo, or in association with multiple endocrine neoplasia (MEN), an autosomal dominant inherited condition. See our notes on MEN syndromes.
The diagnosis is usually made through a combination of both functional testing (confirms endogenous hyperinsulinaemia) and imaging (localises the tumour).
Functional testing
This involves a prolonged 72 hour fast, which aims to induce an episode of hypoglycaemia with subsequent measurement of insulin and C-peptide levels. C-peptide is part of the precursor proinsulin, which is released by beta cells and then cleaved to form insulin and C-peptide. In an insulinoma, there is an inappropriately high level of insulin and C-peptide. In the absence of an underlying disorder, a 72 hour fast should not lead to hypoglycaemia due to counterregulatory hormones and a reduction in insulin secretion.
Following functioning testing, there are a variety of imaging modalities that can be used to localise the tumour (e.g. computed tomography, magnetic resonance imaging). If these are negative, more invasive investigations may be required.
Remember, inappropriately elevated levels of insulin and C-peptide in the context of hypoglycaemia is suggestive of an insulinoma.
Benjamin Norton (@medicalreg)
Final words
Remember to get in contact with any questions, suggestions, or topics that you wish to be covered!
Thanks for reading, remember to tell your friends, and see you next week!
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