Clinical Management of Insulinomas: A Single Institution’s Experience

ABSTRACT

Purpose: Although very rare, insulinomas are the most commonly occurring endocrine tumor of the pancreas. The aim of this study was to review the clinical presentation, diagnostic approach and management of patients with insulinoma.
Material and Method: Twenty-two insulinoma patients  aged between 20 and 79 years were included in the study. The subjects were evaluated according to their clinical presentation, blood biochemistry, imaging studies, operative management, pathological manifestations, postoperative and follow-up outcomes.
Results: We evaluated our medical records of patients who were internalized and underwent a supervised 72-hour fast between 2005-2011 years. Diagnosis of insulinoma was determined in 22 patients [female/male=14/8] by hyperinsuliemia during hypoglycemic episode and was assured in 21 patients with histological investigation after operation. A pancreatic mass was observed on transabdominal ultrasonography or computed tomography in 18 of the 22 [81.8%] patients preoperatively. Postoperative complications, such as postoperative cyst and intra-abdominal infection were observed in six patients.
Discussion: High serum insulin levels during hypoglycemic episode is highly specific for the diagnosis of insulinoma. Ultrasonography and computed tomography appear to be a substantially useful preoperative investigation procedure for localizing a pancreatic adenoma. In unexperienced hands, intraoperative ultrasonography is not highly conclusive procedure for pancreatic tumor localization.