Diagnostic Accuracy of an “Amended” Insulin–Glucose Ratio for the Biochemical Diagnosis of Insulinomas
Authors: Philip E. Cryer, Lloyd Axelrod, Ashley B. Grossman, Simon R. Heller, Elizabeth R. Seaquist
Journal: Annals of Internal Medicine (2013)

Letters19 March 2013Diagnostic Accuracy of an “Amended” Insulin–Glucose Ratio for the Biochemical Diagnosis of InsulinomasPhilip E. Cryer, MD, Lloyd Axelrod, MD, Ashley B. Grossman, MD, Simon R. Heller, MD, Elizabeth R. Seaquist, MD, and F. John Service, MD, PhD, on behalf of the Endocrine Society Task Force on the Evaluation and Management of Adult Hypoglycemic DisordersPhilip E. Cryer, MDFrom Washington University, St. Louis, Missouri; Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Oxford Centre for Diabetes, Endocrinology, and Metabolism, Headington, United Kingdom; Sheffield Teaching Hospitals, Yorkshire, United Kingdom; University of Minnesota, Minneapolis, Minnesota; and Mayo Clinic, Rochester, Minnesota.Search for more papers by this author, Lloyd Axelrod, MDFrom Washington University, St. Louis, Missouri; Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Oxford Centre for Diabetes, Endocrinology, and Metabolism, Headington, United Kingdom; Sheffield Teaching Hospitals, Yorkshire, United Kingdom; University of Minnesota, Minneapolis, Minnesota; and Mayo Clinic, Rochester, Minnesota.Search for more papers by this author, Ashley B. Grossman, MDFrom Washington University, St. Louis, Missouri; Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Oxford Centre for Diabetes, Endocrinology, and Metabolism, Headington, United Kingdom; Sheffield Teaching Hospitals, Yorkshire, United Kingdom; University of Minnesota, Minneapolis, Minnesota; and Mayo Clinic, Rochester, Minnesota.Search for more papers by this author, Simon R. Heller, MDFrom Washington University, St. Louis, Missouri; Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Oxford Centre for Diabetes, Endocrinology, and Metabolism, Headington, United Kingdom; Sheffield Teaching Hospitals, Yorkshire, United Kingdom; University of Minnesota, Minneapolis, Minnesota; and Mayo Clinic, Rochester, Minnesota.Search for more papers by this author, Elizabeth R. Seaquist, MDFrom Washington University, St. Louis, Missouri; Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Oxford Centre for Diabetes, Endocrinology, and Metabolism, Headington, United Kingdom; Sheffield Teaching Hospitals, Yorkshire, United Kingdom; University of Minnesota, Minneapolis, Minnesota; and Mayo Clinic, Rochester, Minnesota.Search for more papers by this author, and F. John Service, MD, PhDFrom Washington University, St. Louis, Missouri; Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Oxford Centre for Diabetes, Endocrinology, and Metabolism, Headington, United Kingdom; Sheffield Teaching Hospitals, Yorkshire, United Kingdom; University of Minnesota, Minneapolis, Minnesota; and Mayo Clinic, Rochester, Minnesota.Search for more papers by this author, on behalf of the Endocrine Society Task Force on the Evaluation and Management of Adult Hypoglycemic DisordersSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-158-6-201303190-00020 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Nauck and Meier (1) reported their use of an amended insulin–glucose ratio, based on the assumption that the insulin concentration is normally zero only at a plasma glucose concentration of 1.7 mmol/L (30 mg/dL), in the diagnosis of insulinoma, and contrasted that experience with the recommendations of the Endocrine Society Clinical Practice Guideline (CPG) on the evaluation and management of adult hypoglycemic disorders (2). Measurements of insulin secretion were not reported in Turner and colleagues' (3) article cited by Nauck and Meier. In fact, plasma C-peptide concentrations and their corresponding insulin secretion rates decline to values not ...References1. Nauck MA, Meier JJ. Diagnostic accuracy of an “amended” insulin-glucose ratio for the biochemical diagnosis of insulinomas. Ann Intern Med. 2012;157:767-75. [PMID: 23208166] LinkGoogle Scholar2. Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER, et al; Endocrine Society. Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2009;94:709-28. [PMID: 19088155] CrossrefMedlineGoogle Scholar3. Turner RC, Oakley NW, Nabarro JD. Control of basal insulin secretion, with special reference to the diagnosis of insulinomas. Br Med J. 1971;2:132-5. [PMID: 4325738] CrossrefMedlineGoogle Scholar4. Heller SR, Cryer PE. Hypoinsulinemia is not critical to glucose recovery from hypoglycemia in humans. Am J Physiol. 1991;261:41-8. [PMID: 1858873] MedlineGoogle Scholar5. Breckenridge SM, Raju B, Arbelaez AM, Patterson BW, Cooperberg BA, Cryer PE. Basal insulin, glucagon, and growth hormone replacement. Am J Physiol Endocrinol Metab. 2007;293:1303-10. [PMID: 17711984] CrossrefMedlineGoogle Scholar6. Placzkowski KA, Vella A, Thompson GB, Grant CS, Reading CC, Charboneau JW, et al. Secular trends in the presentation and management of functioning insulinoma at the Mayo Clinic, 1987-2007. J Clin Endocrinol Metab. 2009;94:1069-73. [PMID: 19141587] CrossrefMedlineGoogle Scholar7. Vezzosi D, Bennet A, Fauvel J, Caron P. Insulin, C-peptide and proinsulin for the biochemical diagnosis of hypoglycaemia related to endogenous hyperinsulinism. Eur J Endocrinol. 2007;157:75-83. [PMID: 17609405] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Washington University, St. Louis, Missouri; Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Oxford Centre for Diabetes, Endocrinology, and Metabolism, Headington, United Kingdom; Sheffield Teaching Hospitals, Yorkshire, United Kingdom; University of Minnesota, Minneapolis, Minnesota; and Mayo Clinic, Rochester, Minnesota.Disclosures: Dr. Cryer: Consultancy: Marcadia Biotech; Grants/grants pending (money to institution): National Institutes of Health (grants R37-DK27085, MO1-RR00036, P60-DK20579, and T32-DK07120), American Diabetes Association Fellowship (award 7-09-MN-10 and grant 1-11-CT-14); Payment for lectures including service on speakers bureaus: Novo Nordisk, Bristol-Myers Squibb/AstraZeneca, Merck; Royalties: American Diabetes Association. Dr. Seaquist: Board membership: American Diabetes Association; Employment: University of Minnesota; Grants/grants pending (money to institution): American Diabetes Association, National Institutes of Health, Eli Lilly, Minneapolis Medical Research Foundation; Payment for lectures including service on speakers bureaus (money to self and institution): Endocrine Society, Japan Diabetes Society, Intellyst Medical Education; Travel/accommodations/meeting expenses unrelated to activities listed: American Diabetes Association, National Institutes of Health; Other (money to institution): Endocrine Society. All other authors have no disclosures. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDiagnostic Accuracy of an “Amended” Insulin–Glucose Ratio for the Biochemical Diagnosis of Insulinomas Michael A. Nauck and Juris J. Meier Diagnostic Accuracy of an “Amended” Insulin–Glucose Ratio for the Biochemical Diagnosis of Insulinomas Michael A. Nauck and Jurus J. Meier Metrics Cited ByAn observational analysis of insulinoma from a single institution 19 March 2013Volume 158, Issue 6Page: 500-501KeywordsAttentionBlood plasmaGlucoseInsulinInsulin resistanceInsulin secretionInsulinomaMedical educationSpecificityTreatment guidelines ePublished: 19 March 2013 Issue Published: 19 March 2013 CopyrightCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...