Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
Endocrine Metabolic and Diabetes Division, Internal Medicine Department, Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta Indonesia.
J ASEAN Fed Endocr Soc. 2024;39(1):79-83. doi: 10.15605/jafes.039.01.16. Epub 2024 Feb 5.
Insulinoma is one of the causes of recurrent hypoglycemia, one of the chief complaints for emergency department admission. The gold standard in diagnosing insulinoma is a 72-hour fasting test which is inconvenient and inefficient as it requires hospitalization. Research has found that measurement of insulin and C-peptide during OGTT may help diagnose insulinoma. We aimed to assess the diagnostic value of OGTT in diagnosing insulinoma.
The literature search was conducted on 19 August 2022 using several databases (MEDLINE, Scopus, Embase, and ScienceDirect). All studies that measured OGTT as diagnostic tools in diagnosing insulinoma and 72-hour fasting test as reference standard were included. The quality assessment of the selected studies was based on the Centre of Evidence-Based Medicine University of Oxford and the Quality Assessment of Diagnostic Accuracy-2 tool (QUADAS-2). Analysis of the included studies was performed qualitatively. This study was registered on PROSPERO (CRD42022360205).
A total of two case-control studies (106 patients) were included, which were at risk of bias and low concern of applicability. Both studies demonstrated that the combination of insulin and C-peptide levels measured during OGTT had high specificity, sensitivity, positive predictive value, and negative predictive value in diagnosing insulinoma compared to the reference standard. A logistic regression model of 8.305 - (0.441 × insulin 2-h/0-h) - (1.679 × C-peptide 1-h/0-h) >0.351 has the highest diagnostic value in one study (AUC 0.97, Sensitivity 86.5%, Specificity 95.2%, PPV 94.1, NPV 88.9).
The measurement of 0-h and 2-h insulin and C-peptide levels during 2-h OGTT was found in two small case-control studies with a total of 106 patients to have good sensitivity and specificity. However, due to these limitations, future research is still needed to validate the potential use of OGTT for the diagnosis of insulinoma.
胰岛素瘤是反复发生低血糖的原因之一，也是急诊科收治的主要原因之一。诊断胰岛素瘤的金标准是 72 小时禁食试验，但该试验需要住院，既不方便也不高效。研究发现，口服葡萄糖耐量试验（OGTT）期间胰岛素和 C 肽的测量可能有助于诊断胰岛素瘤。我们旨在评估 OGTT 诊断胰岛素瘤的诊断价值。
我们于 2022 年 8 月 19 日使用多个数据库（MEDLINE、Scopus、Embase 和 ScienceDirect）进行了文献检索。所有测量 OGTT 作为诊断胰岛素瘤的工具并以 72 小时禁食试验作为参考标准的研究均被纳入。所选研究的质量评估基于牛津大学循证医学中心和诊断准确性评估-2 工具（QUADAS-2）。对纳入的研究进行定性分析。本研究已在 PROSPERO（CRD42022360205）上注册。
共纳入两项病例对照研究（共 106 例患者），这些研究存在偏倚风险和适用性问题。两项研究均表明，与参考标准相比，OGTT 期间测量的胰岛素和 C 肽水平的组合在诊断胰岛素瘤方面具有较高的特异性、敏感性、阳性预测值和阴性预测值。一项研究中，8.305-（0.441×胰岛素 2 小时/0 小时）-（1.679×C 肽 1 小时/0 小时）>0.351 的逻辑回归模型具有最高的诊断价值（AUC 0.97，敏感性 86.5%，特异性 95.2%，PPV 94.1%，NPV 88.9%）。
两项共纳入 106 例患者的小型病例对照研究发现，2 小时 OGTT 期间测量的 0 小时和 2 小时胰岛素和 C 肽水平具有较好的敏感性和特异性。但是，由于这些局限性，仍需要进一步的研究来验证 OGTT 诊断胰岛素瘤的潜在用途。
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