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Insulinoma--clinical experience in ten cases
H Y Chang1, H S Huang, J D Lin
1Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C.
Changgeng Yi Xue Za Zhi
|March 1, 1994
Summary
This study on insulinoma patients found that diagnostic tests like fasting and oral glucose tolerance tests confirmed hyperinsulinism. Surgical removal of benign tumors resolved hypoglycemia, though some patients developed diabetes post-operation.
Area of Science:
- Endocrinology
- Surgical Oncology
- Diagnostic Imaging
Background:
- Insulinoma, a rare pancreatic tumor, causes hypoglycemia due to excessive insulin secretion.
- Patients typically present with neuroglycopenic symptoms and Whipple's triad.
- Accurate diagnosis and localization are crucial for successful surgical management.
Purpose of the Study:
- To evaluate diagnostic methods and treatment outcomes for pathologically confirmed insulinoma.
- To assess the efficacy of various imaging techniques in localizing insulinomas.
- To analyze surgical results and long-term glycemic control after tumor resection.
Main Methods:
- Retrospective analysis of 10 insulinoma patients (1981-1992).
- Evaluation of diagnostic tests including fasting, oral glucose tolerance test (OGTT), and calcium infusion test.
- Assessment of imaging modalities: ultrasonography, CT scan, arteriography, transhepatic portal venous sampling (THPVS), endoscopic ultrasonography, and intraoperative ultrasonography.
- Surgical intervention (enucleation, subtotal/distal pancreatectomy) followed by postoperative monitoring.
Main Results:
- 90% of patients showed an elevated insulin to glucose ratio after fasting.
- Supervised fasting and OGTT identified hyperinsulinism in most patients.
- Localization rates varied: THPVS (100%), arteriography (50%), CT scan (37.5%), ultrasonography (12.5%).
- All 10 patients had single, benign islet cell adenomas, primarily in the pancreatic body and tail.
- Post-surgery, hypoglycemia resolved, but 2 patients developed persistent hyperglycemia (NIDDM).
Conclusions:
- Diagnostic tests effectively confirm insulinoma by demonstrating hyperinsulinism.
- Transhepatic portal venous sampling and intraoperative ultrasonography are highly effective for tumor localization.
- Surgical resection is curative for hypoglycemia, but careful monitoring is needed for potential postoperative diabetes.