Insulinoma and Rare Endocrine Tumors: What You'll See Once and Never Forget

Dr. Rosemary Stolzer, DVMCaninePre-RACE approval · credit hours set at approval

This course is built around the cases that reward the clinician who looks beyond the obvious. Rex, a 10-year-old Irish Setter, has been on phenobarbital for two weeks for 'epilepsy' when a single blood glucose measurement changes everything. The course follows his journey from misdiagnosis through biochemical confirmation, WHO staging, partial pancreatectomy, complete remission, and eventual micrometastatic recurrence. A final module covers the rare endocrine zebras — pheochromocytoma, feline hyperaldosteronism, and feline acromegaly — presented with the specific clinical features that, once learned, are never forgotten.

Learning Objectives

  • 1Apply Whipple's triad to evaluate episodic collapse in a middle-aged to older large-breed dog, prioritize glucose measurement before initiating anticonvulsant therapy, and interpret a concurrent insulin level drawn at the time of documented hypoglycemia
  • 2Calculate the Amended Insulin-to-Glucose Ratio (AIGR) and explain its limitations, assign a WHO stage (I, II, or III) based on imaging findings, and select the appropriate treatment pathway — surgery versus medical management — for each stage
  • 3Prescribe the complete medical management protocol for canine insulinoma including dietary modification, prednisone at 0.25-0.5 mg/kg PO q12h, diazoxide at 5-10 mg/kg PO q12h, and the in-clinic and home emergency hypoglycemia protocols
  • 4Describe the key perioperative considerations for partial pancreatectomy in an insulinoma patient — including modified fasting, perioperative dextrose CRI, intraoperative glucose monitoring, and interpretation of post-operative transient hyperglycemia
  • 5Recognize the clinical presentations of pheochromocytoma, feline hyperaldosteronism (Conn's syndrome), and feline acromegaly, and describe the critical management principles for each: alpha-blockade before beta-blockade for pheochromocytoma, the aldosterone:renin ratio for hyperaldosteronism, and IGF-1 measurement plus radiation therapy for feline acromegaly

Course Syllabus

  1. 1
    Meet Rex: The Seizure That Isn't EpilepsyPreview

    module-1-meet-rex

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    8 min
  2. 2
    Insulinoma Biology and Diagnosis

    module-2-insulinoma-diagnosis

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    9 min
  3. 3
    Medical Management: Keeping Glucose Up

    module-3-medical-management

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    9 min
  4. 4
    Surgery and Advanced Options

    module-4-surgery

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    8 min
  5. 5
    The Rare Endocrine Zebras

    module-5-rare-tumors

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    9 min
  6. 6
    Rex's Journey and the Rare Tumor Mindset

    module-6-case-resolution

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    8 min

Final Assessment

10 questions · Passing score: 70%

Complete all course modules to unlock the assessment. Upon passing, your certificate of completion will be generated automatically.