Table 1: Pancreatic Neuroendocrine Tumors

Table 1:
Pancreatic Neuroendocrine Tumors
Tumor Type	%^A	Secretory Product	Clinical Features	Laboratory Testing	Symptomatic Treatment
Insulinoma	40-60	Insulin	Hypoglycemia Symptoms of catecholamine excess 90% benign	Insulin level/ C-peptide 72-hour inpatient fast with monitoring of glucose and insulin levels	Dietary measures Octreotide Diazoxide
Gastrinoma	20-50	Gastrin	Peptic ulcer disease GERD Secretory diarrhea Most common NET in MEN 1 60% to 90% malignant	Fasting serum gastrin Gastric pH analysis Gastrin provocation testing (calcium or secretin challenge)	Proton pump inhibitor Octreotide
Glucagonoma	Rare	Glucagon	Glucose intolerance Migratory necrolytic erythema Weight loss Anemia 90% malignant	Serum glucagon	Octreotide Insulin Zinc supplement (rash) TPN (malnutrition)
Somatostatinoma	Rare	Somatostatin	Diabetes Gallstones Secretory diarrhea	Clinical and pathologic diagnosis Increased somatostatin-like immunoreactivity in resected tumor	Octreotide
VIPoma	Rare	Vasoactive intestinal peptide	Cholera-like, secretory diarrhea Hypokalemia Hypochlorhydria	Serum VIP	Octreotide
^APercent among neuroendocrine tumors, GERD = gastroesophageal reflux disease; MEN 1 = multiple endocrine neoplasia type 1; NET = neuroendocrine tumor; TPN = total parenteral nutrition; VIP = vasoactive intestinal peptide