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[Pancreatic endocrine tumors].

E Târcoveanu1, R Moldovanu, St Georgescu

  • 1Clinica I Chirurgie Spitalul Sf Spiridon, Iaşi. etarco@iasi.mednet.ro

Chirurgia (Bucharest, Romania : 1990)
|June 7, 2006
PubMed
Summary

This study reviewed 10 cases of pancreatic endocrine tumors, including insulinoma, gastrinoma, and non-functioning tumors. Early diagnosis and surgical intervention improved outcomes for insulinoma patients, while gastrinoma cases were fatal due to delayed diagnosis.

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Area of Science:

  • Endocrinology
  • Surgical Oncology
  • Gastroenterology

Context:

  • Pancreatic endocrine tumors (PETs) are rare, with an incidence of 4-10 per million people.
  • This study analyzes 10 PET cases operated between 1984-2003, representing 2.21% of all pancreatic tumors.
  • The cases included insulinoma, gastrinoma, Wermer syndrome, and non-functioning PETs, with a notable female predominance (9/1 ratio).

Purpose:

  • To present a case series of operated pancreatic endocrine tumors.
  • To highlight diagnostic challenges, particularly for insulinoma, and surgical management strategies.
  • To discuss outcomes and diagnostic difficulties associated with different types of PETs.

Summary:

  • Four insulinoma cases (all female) experienced diagnostic delays of 2-5 years due to misinterpretation of hypoglycemia symptoms. Diagnosis relied on Whipple triad and biochemical tests. Surgical treatment involved distal pancreatectomy or spleen-preserving pancreatectomy, with successful symptom resolution.

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  • Two gastrinoma cases, complicated by severe ulcers, were diagnosed post-mortem, emphasizing the critical need for early detection.
  • Two Wermer syndrome cases presented with ulcers and other endocrine neoplasias (parathyroid, pituitary, thyroid). Surgical approaches varied, including pancreatectomy and gastrectomy.
  • Two non-functioning PETs had non-specific symptoms, diagnosed via ultrasound. Surgical management included spleno-pancreatectomy or spleen-preserving pancreatectomy with uneventful recovery.

    • Impact:

    • Demonstrates the importance of recognizing subtle symptoms for early insulinoma diagnosis and effective surgical treatment.
    • Underscores the high mortality associated with delayed gastrinoma diagnosis and the need for prompt investigation of gastrointestinal bleeding.
    • Highlights the complex management of Wermer syndrome and non-functioning PETs, emphasizing the role of imaging and tailored surgical approaches.