Search

Pancreatic neuroendocrine tumors (PNETs) are rare endocrine tumors originating from pancreatic cells, constituting 1-2% of pancreatic tumors. The incidence of PNETs has risen from 0.32 to 0.48 per 100,000 people between 2004 and 2021. Among PNETs, insulinomas are the most common type, characterized by excessive insulin production, with an occurrence rate of 1-4 per million people. This review provides a comprehensive analysis of insulinomas, focusing on their epidemiology, pathophysiology, clinical manifestations, diagnostic methods, and treatment strategies. Insulinomas can be sporadic or associated with Multiple Endocrine Neoplasia Type 1 (MEN-1) syndrome, a genetic disorder caused by mutations in the MEN1 gene. MEN-1-associated insulinomas are often diagnosed earlier and may present as multicentric lesions, whereas sporadic insulinomas are typically solitary and benign. Diagnostic approaches include biochemical tests, such as the 72-hour fasting test, and imaging techniques like CT, MRI, and nuclear medicine scans for tumor localization. Surgical resection remains the primary treatment modality, with high success rates for benign tumors, although emerging techniques like endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) offer promising alternatives for small, solitary tumors. Medical management, including medications like diazoxide and somatostatin analogs, is crucial for controlling symptoms in patients not amenable to surgery. Prognosis is generally favorable with surgical intervention, but careful monitoring is required for malignant or metastatic disease. Ongoing research is essential to enhance treatment strategies and improve patient outcomes.

Shooting may impact the frequency of neuropathies in the upper extremity nerves or of cervical disc–root conflicts. This study was undertaken to assess whether shooting sports trained with a handgun by civilians may influence the risk factor for carpal tunnel syndrome (CTS) and other neuropathies of the brachial plexus nerve fibers. Neurophysiological studies using surface electromyography (rEMG at rest and mcEMG during maximal contraction), electroneurography (ENG), and motor-evoked potential recordings (MEPs) were performed in a select population of nine shooters, which were rigorously screened as positive through a clinical examination for carpal tunnel syndrome and other brachial plexus neuropathies among a population of forty-two subjects, to confirm the existence of pathologies in the upper extremities. Increased muscle tension in rEMG and a simultaneous decrease in motor unit activity in mcEMG were recorded both in the proximal and distal muscles of the upper extremities more frequently in the shooters than in the healthy controls—volunteers. An ENG examination confirmed CTS in the shooting hand of four subjects (4/42; 9.5%), additionally revealing a significantly decreased F-wave at the C6–C7 levels in the dominant extremities of the shooting group in comparison to the control population (p = 0.05). All the examined subjects had revealed brachial plexus pathologies on both sides according to the results of the MEP recordings upon stimulation at the C4–C8 levels (various significant differences between the shooters and control group were found), and two had ulnar neuropathy in the wrist on the shooting side. It was concluded that shooting sports are a moderate risk factor for carpal tunnel syndrome and that they significantly influence the development of other brachial plexus neuropathies.