Insulinoma Diagnosis in a Dog

Insulinoma Diagnosis in a Dog Manyevitch, Shelly An 8-year-old female spayed Golden Retriever was presented with a history of two episodes of weakness within a sixty-second-timespan following periods of brief exercise. Investigative procedures included complete blood counts, serum chemistry profiles, hormone assays, abdominal ultrasound, computed tomography with contrast, exploratory laparotomy and histopathology. Results of these investigations revealed fasting hypoglycemia (blood glucose 47mg/dL, fasting hyperinsulinism (>200 uIU/mL) and an elevated fasting insulin to glucose ratio of>4.65. Abdominal ultrasound revealed numerous nodules in the liver with no visualized pancreatic mass. Computed tomography revealed an ill-defined nodule with heterogenous soft tissue attenuation and mild primarily peripheral contrast enhancement within the left limb of the pancreas. Liver nodules on computed tomography were appreciated but not noted to contrast enhance. Treatment included medical management and exploratory laparotomy. Exploratory laparotomy successfully located the primary pancreatic mass and also revealed numerous presumptive metastatic lesions on the surface of the liver. A partial pancreatectomy, partial liver lobectomy and metastasectomy were performed. These masses were submitted to pathology for histological categorization. A diagnosis of a neuroendocrine carcinoma with liver metastatic lesions was ultimate! y confirmed by histopathology. Medical management in the form of meals every 4 hours with w/d canned diet as well at 10mg of prednisone BID was utilized to maintain euglycemia prior to surgery and for long term management.