[The newest perspectives on diagnostic methods and treatment of insulinoma]

Insulinoma is the most common hormonally active neuroendocrine tumor of the pancreas. Low blood sugar, caused by excessive secretion of insulin from the tumor cells, leads to a variety of symptoms (e.g. signs of neuroglycopaenia), that may be mistaken for diseases of the central nervous system, psychiatric disturbances or cardiovascular conditions. That is why a lot of attention should be brought to the diagnostic tests towards insulinoma. The development of imaging techniques in the past years has lead to the possibility of locating an insulinoma of a few milimetres in size, which is helpful to avoid the need of a blind resection and preserves the pancreatic parenchyma. 90% of insulinomas are benign and surgery is the treatment of choice. However, as in any neuroendocrine tumor, a malignant form may occur--resection of the metastases is the only curative method, but radiofrequency ablation, selective internal radiation therapy, hepatic artery embolization or chemoembolization, can also have positive therapeutic applications. Systemic therapies regarding malignant insulinoma are: chemotherapy, somatostatin analogs, radiolabelled somatostatin analogs and the newly developed biological targeted therapies such as everolimus--oral inhibitor of the mammalian target of rapamycin, and sunitinib--the tyrosine kinase inhibitor.