[Insulinoma: experience in our hospital]

Insulinoma is the most frequent endocrinal tumor of the pancreas despite its very low incidence. This lesion induces hyperinsulinism, which has an atypical clinical symptomatology consisting of neurological symptoms and of signs by stimulation of the adrenergic system. Biological analyzes serve to confirm the presence of uncontrolled hyperinsulinism. Preoperative abdominal echography, abdominal CT-SCAN, angiography and portal catheterization serve to detect the pancreatic site of the insulinoma only in about 3/4 of the cases. However, the perioperative combination of manual palpation and abdominal echography reveal the exact site in almost all cases. For all these reasons we do not recommend attempting preoperative localization of the insulinoma and propose surgery as the treatment of choice when the diagnosis is established by biological features. Medical treatment is only applied to inoperable cases or in the presence of metastatic lesions. Surgical treatment should be economical on the pancreas and should be based solely on resection of the lesion, simple enucleation being the treatment of choice when the neighboring vascularly, biliary and digestive structures do not represent any technical risk. Whenever this is impracticable, right or left pancreatectomy seems to be the best option. We report our experience with 25 patients and analyze the benefits of pre- and perioperative examinations in the localization of insulinomas.