Important "negative" report confirming a clinical pearl
Run Yu, Cedars-Sinai Medical Center
8 September 2014
I commend BMC Endocrine Disorders on publishing this article by Qiao et al who report that CGA levels are usually normal in patients with insulinomas. To be frank, the results are not surprising to specialists on neuroendocrine tumors. Insulinoma workup algorithm does not require CGA measurement. Insulinoma diagnosis is based on hyperinsulinemic hypoglycemia and pancreatic mass. In clinical practice, though, I often see non-specialist physicians order CGA test and use a normal CGA result as evidence against insulinoma. When I discuss with non-specialist physicians about CGA in insulinoma diagnosis, they often ask if there is a study to support my experience. Now I can point to this paper for evidence.
There are many clinical "pearls" in medicine based on clinical experience. The origin of the pearls is often unclear and the veracity uncertain. One example of an endocrine pearl that turns out to be not so true is the "A single thyroid nodule is more likely malignant than multiple nodules". The pearls need to be studied so that they will be classified as either real pearls or just plastic balls. The study by Qiao et al confirms one pearl known to specialists. More such studies are needed to test the purity of clinical pearls.
Important "negative" report confirming a clinical pearl
8 September 2014
I commend BMC Endocrine Disorders on publishing this article by Qiao et al who report that CGA levels are usually normal in patients with insulinomas. To be frank, the results are not surprising to specialists on neuroendocrine tumors. Insulinoma workup algorithm does not require CGA measurement. Insulinoma diagnosis is based on hyperinsulinemic hypoglycemia and pancreatic mass. In clinical practice, though, I often see non-specialist physicians order CGA test and use a normal CGA result as evidence against insulinoma. When I discuss with non-specialist physicians about CGA in insulinoma diagnosis, they often ask if there is a study to support my experience. Now I can point to this paper for evidence.
There are many clinical "pearls" in medicine based on clinical experience. The origin of the pearls is often unclear and the veracity uncertain. One example of an endocrine pearl that turns out to be not so true is the "A single thyroid nodule is more likely malignant than multiple nodules". The pearls need to be studied so that they will be classified as either real pearls or just plastic balls. The study by Qiao et al confirms one pearl known to specialists. More such studies are needed to test the purity of clinical pearls.
Competing interests
None.