Gastrointestinal endocrine tumours. Insulinoma

Area of Science:

• Endocrinology
• Surgical Oncology
• Diagnostic Medicine

Background:

• Insulinoma diagnosis relies on recognizing hypoglycemia symptoms, particularly neuroglycopenia.
• Hypoglycemia can stem from various disorders, but endogenous hyperinsulinism alongside hypoglycemia is diagnostic of insulinoma.

Purpose of the Study:

• To outline diagnostic criteria for insulinoma.
• To discuss current localization techniques and surgical management strategies.
• To highlight potential complications and the curative nature of benign insulinoma excision.

Main Methods:

• Establishing diagnosis through specific biochemical criteria: glucose ≤ 40 mg/dL, insulin ≥ 6 μU/mL, C-peptide > 200 pmol/L, and negative sulfonylurea screen.
• Utilizing pre-operative and intraoperative ultrasonography for tumor localization.
• Surgical intervention via enucleation or distal pancreatectomy.

Main Results:

• The combination of hypoglycemia and endogenous hyperinsulinism confirms insulinoma.
• Pre-operative ultrasound is presented as the primary localization tool.
• Enucleation is the preferred surgical technique, with distal pancreatectomy as a viable alternative; pancreatoduodenectomy is rarely needed.
• Complications primarily involve pancreatic fluid leaks; excision of benign insulinomas typically results in a cure.

Conclusions:

• Accurate diagnosis of insulinoma is achieved through a combination of clinical presentation and specific biochemical markers.
• Ultrasonography is crucial for effective tumor localization and surgical planning.
• Surgical excision offers a definitive cure for most insulinomas, significantly improving patient outcomes.