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The role of proinsulin and insulin in the diagnosis of insulinoma: a critical evaluation of the Endocrine Society clinical practice guideline.

ABSTRACT: An end of fast insulin ? 3 ?IU/mL and a proinsulin concentration ? 5 pmol/L have been suggested as useful cutoffs for the diagnosis of insulinoma.The main objective was to evaluate the diagnostic performance of an end of fast insulin concentration ? 3 ?IU/mL and an end of fast proinsulin concentration ? 5 pmol/L.The design was a case-control series.The setting was a tertiary-care center.Fifty-six subjects with a positive 48-hour supervised fast had an insulinoma between June 2000 and April 2011. During this same time period, a diagnosis of insulinoma was excluded in 29 subjects who underwent a supervised fast.48-hour supervised fast.The main outcome measures were serum insulin concentration and plasma proinsulin concentration.Ninety-one percent of the patients with an insulinoma had a measured insulin concentration ?5 ?IU/mL at the end of fast. The sensitivity increased to 98% if the threshold to define inadequate insulin suppression was lowered to ?3 ?IU/mL. The median (interquartile range) end of fast proinsulin was 100 (53-270) pmol/L for cases and 6.8 (4.2-12.0) pmol/L for controls. An end of fast proinsulin value of ? 5 pmol/L could not distinguish cases from controls (59% false positive rate). All patients with an insulinoma (sensitivity 100%) and none of the control subject (specificity 100%) had end of fast proinsulin concentration ? 27 pmol/L.Using a current insulin assay 9% of insulinoma cases end the supervised fast with an insulin concentration below 5 ?IU/mL. Inadequate insulin suppression defined using a threshold of ? 3 ?IU/mL increases the sensitivity of the test. The value of the proinsulin test lies in its unique ability to distinguish cases from controls. A proinsulin concentration of ?22 pmol/L best discriminates cases from controls. Reliance on an end of fast proinsulin cutoff value of 5 pmol/L does not augment sensitivity but greatly reduces specificity of the test.

SUBMITTER: Guettier JM

PROVIDER: S-EPMC3849676 | biostudies-literature | 2013 Dec

REPOSITORIES: biostudies-literature

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The role of proinsulin and insulin in the diagnosis of insulinoma: a critical evaluation of the Endocrine Society clinical practice guideline.

Guettier Jean-Marc JM Lungu Andreea A Goodling Anne A Cochran Craig C Gorden Phillip P

The Journal of clinical endocrinology and metabolism 20130930 12

<h4>Context</h4>An end of fast insulin ≥ 3 μIU/mL and a proinsulin concentration ≥ 5 pmol/L have been suggested as useful cutoffs for the diagnosis of insulinoma.<h4>Objective</h4>The main objective was to evaluate the diagnostic performance of an end of fast insulin concentration ≥ 3 μIU/mL and an end of fast proinsulin concentration ≥ 5 pmol/L.<h4>Design</h4>The design was a case-control series.<h4>Setting</h4>The setting was a tertiary-care center.<h4>Patients</h4>Fifty-six subjects with a po ...[more]

PMID: 24081736

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Dataset Information

The role of proinsulin and insulin in the diagnosis of insulinoma: a critical evaluation of the Endocrine Society clinical practice guideline.

Publications

The role of proinsulin and insulin in the diagnosis of insulinoma: a critical evaluation of the Endocrine Society clinical practice guideline.

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