Comparison of the diagnostic accuracy of the current guidelines for detecting insulinoma

in European Journal of Endocrinology
Correspondence should be addressed to K Müssig; Email:
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Insulinomas are rare pancreatic endocrine tumors characterized by hypoglycemia. Guidelines by the Endocrine Society (ES), the European (ENETS) and the North American (NANETS) Neuroendocrine Tumor Societies provide divergent diagnostic criteria. This study compared the diagnostic accuracy of these different criteria during the 72-h fasting test.


Retrospective cohort study.


From 2000 to 2014, 64 patients with a suspected insulinoma underwent a 72-h fasting test and were included in the analysis. This study assessed the diagnostic sensitivity, specificity and accuracy based on venous blood glucose and corresponding insulin levels measured by electrochemiluminescence immunoassay (ECLIA).


Based on 64 individuals (18 with, 46 without insulinoma), the ES criteria provided a diagnostic sensitivity of 0.94 (0.73–1.00), specificity of 0.89 (0.76–0.96) and accuracy of 0.91 (0.81–0.96). ENETS/NANETS criteria reached a diagnostic sensitivity of 0.78 (0.52–0.94), specificity of 1.00 (0.92–1.00) and accuracy of 0.94 (0.85–0.98).


These results point to a higher diagnostic sensitivity with less specificity for diagnosing insulinoma using ES criteria and a higher specificity at lower sensitivity by using ENETS/NANETS criteria. Before considering these results when applying the different criteria in clinical practice, the results should be confirmed in further studies comprising larger cohorts.

Downloadable materials

  • Supplementary Table 1: Diagnostic criteria for insulinomas
  • Supplementary Table 2: Individual data of the study cohort
  • Supplementary Table 3: Diagnostic accuracy of the guidelines’ criteria at the end of the fasting test
  • Supplementary Table 4: Diagnostic accuracy of insulin-glucose ratios of the entire study cohort (n=64)


     European Society of Endocrinology

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  • View in gallery

    Minimal venous blood glucose measurements of the patients with (black square) and without (black open circles) an insulinoma during the fasting test plotted versus the corresponding ln-transformed insulin values. Insulin was ln-transformed prior to analysis to achieve a normal distribution. X-axis shown with natural logarithm scale. Lines illustrate the glucose and insulin thresholds of the ES guideline (black line) and of the ENETS and NANETS guidelines (dotted line).

  • View in gallery

    Area under the receiver operating characteristic curve (AROC) of the simple (black line) and the amended insulin-glucose ratios (black dotted line).


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