Insulinoma: a clinical study of 18 cases
Journal
Taiwan yi xue hui za zhi. Journal of the Formosan Medical Association
Journal Volume
79
Journal Issue
3
Date Issued
1980-03
Author(s)
Abstract
During the 32-year period of 1948-1979, a total of 18 patients with insulinoma were surgically treated at the National Taiwan University Hospital. Among these 18 patients 15 had a single benign tumor, one had 2 benign tumors, and the other 2 had malignant tumors, one with 4 isolated tumors but without metastasis and the other an infiltrative tumor with multiple liver metastasis. These tumors, totalling 22 in number, ranged in size from 0.5 to 3.0 cm, mostly 1.0 to 2.0 cm, in the largest diameter. Symptoms arising from varying degrees of neuroglycopenia are intermittent and recur in the food-deprived state at irregular intervals over an average of 2.5 years. There were no abdominal signs, but some neurological and EEG abnormalities were found during hypoglycemic attacks and in cases with brain damage. Diagnosis requires repeated demonstration of hypoglycemia (blood glucose below 50 mg/dl) during spontaneous or provoked symptoms, relief with administration of carbohydrates, simultaneous hyperinsulinemia (serum insulin over 30 μU/ml) and absence of insulin antibodies. The useful diagnostic adjuncts were the prolonged fasting test, amended I/G ratio and intravenous tolbutamide test. The most reliable procedure for preoperative localization of the tumor was selective celiac and superior mesenteric arteriography. A well localized tumor stain was demonstrated in 10 out of 12 patients (83%). The only radical treatment for insulinoma is surgical extirpation. Simple enucleation was done in 11 patients with tumors located in the head of the pancreas or superficially located in the body or tail of the pancreas, and distal pancreatectomy in 7 patients with tumors located deep in the body or tail of the pancreas. For malignant tumors, besides surgical extirpation of the primary lesion, metastatic lesions were treated by streptozotocin. After the successful removal of insulinoma, a transient rebound hyperglycemia for one to 3 weeks was the rule but no treatment was indicated. The follow-up time ranged from 6 months to 13.8 years. The prognoses of benign tumors were excellent and those of malignant tumors variable according to the degree of spread and the response to chemotherapy.
SDGs
Type
journal article