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The surgical management of insulinoma.
Bol Asoc Med P R. 2004 Jan-Feb; 96(1):33-8.BA

Abstract

Insulinoma is the most common endocrine tumor of the pancreas. Over 90% of the insulinomas are benign and single, and can be cured by simple excision. Depending on the location, insulinomas can be enucleated, might require partial or distal pancreatectomy or pancreaticoduodenectomy. Five cases with insulinoma successfully treated by surgical intervention, two by enuclation, two by distal pancreatectomy and splenectomy, and preservation of the spleen have been summarized. The management of insulinoma involves the diagnosis, localization of the tumor and treatment. Insulinomas are rare tumors of the pancreas. Nevertheless, it is the most common endocrine tumor of the pancreas. Specifically arising from the beta cells, of the islets of Langerham, that produce insulin (fig.1). Its incidence is one in 250,000 inhabitants. It can be seen at any age, but is more frequent in females between 4 and 82 years of age, with a mean of 45.5 years. Insulinomas are evenly distributed between the head, body and tail of the pancreas. Over 90% are benign and single and can be cured by simple excision. Depending on the location insulinomas can be enucleated, might require partial or distal pancreatectomy or a pancreaticoduodenectomy. Ten percent could be malignant when metastasis to peripancreatic lymph nodes or to the liver is detected. The course of the patient with malignant insulinoma is an indolent one. The release of insulin leads to fasting hypoglycemia producing confusion, loss of consciousness, coma or convulsions. The hypoglycemia in turn can induce the release of cathecolamines producing tachycardia, tremulousness and diaphoresis. The Whipple's triad must be present for the diagnosis of insulinoma; symptoms of hypoglycemia, glucose level below 50 mgs/dl and relief of symptoms by the administration of glucose. In large series the interval between the onset of symptoms and a definitive diagnosis of insulinoma was 37 months, with a range of 0 to 14 years.

Authors+Show Affiliations

evazquez@isla.net

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

15575328

Citation

Vázquez Quintana, Enrique. "The Surgical Management of Insulinoma." Boletin De La Asociacion Medica De Puerto Rico, vol. 96, no. 1, 2004, pp. 33-8.
Vázquez Quintana E. The surgical management of insulinoma. Bol Asoc Med P R. 2004;96(1):33-8.
Vázquez Quintana, E. (2004). The surgical management of insulinoma. Boletin De La Asociacion Medica De Puerto Rico, 96(1), 33-8.
Vázquez Quintana E. The Surgical Management of Insulinoma. Bol Asoc Med P R. 2004 Jan-Feb;96(1):33-8. PubMed PMID: 15575328.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The surgical management of insulinoma. A1 - Vázquez Quintana,Enrique, PY - 2004/12/4/pubmed PY - 2005/2/9/medline PY - 2004/12/4/entrez SP - 33 EP - 8 JF - Boletin de la Asociacion Medica de Puerto Rico JO - Bol Asoc Med P R VL - 96 IS - 1 N2 - Insulinoma is the most common endocrine tumor of the pancreas. Over 90% of the insulinomas are benign and single, and can be cured by simple excision. Depending on the location, insulinomas can be enucleated, might require partial or distal pancreatectomy or pancreaticoduodenectomy. Five cases with insulinoma successfully treated by surgical intervention, two by enuclation, two by distal pancreatectomy and splenectomy, and preservation of the spleen have been summarized. The management of insulinoma involves the diagnosis, localization of the tumor and treatment. Insulinomas are rare tumors of the pancreas. Nevertheless, it is the most common endocrine tumor of the pancreas. Specifically arising from the beta cells, of the islets of Langerham, that produce insulin (fig.1). Its incidence is one in 250,000 inhabitants. It can be seen at any age, but is more frequent in females between 4 and 82 years of age, with a mean of 45.5 years. Insulinomas are evenly distributed between the head, body and tail of the pancreas. Over 90% are benign and single and can be cured by simple excision. Depending on the location insulinomas can be enucleated, might require partial or distal pancreatectomy or a pancreaticoduodenectomy. Ten percent could be malignant when metastasis to peripancreatic lymph nodes or to the liver is detected. The course of the patient with malignant insulinoma is an indolent one. The release of insulin leads to fasting hypoglycemia producing confusion, loss of consciousness, coma or convulsions. The hypoglycemia in turn can induce the release of cathecolamines producing tachycardia, tremulousness and diaphoresis. The Whipple's triad must be present for the diagnosis of insulinoma; symptoms of hypoglycemia, glucose level below 50 mgs/dl and relief of symptoms by the administration of glucose. In large series the interval between the onset of symptoms and a definitive diagnosis of insulinoma was 37 months, with a range of 0 to 14 years. SN - 0004-4849 UR - https://www.unboundmedicine.com/medline/citation/15575328/The_surgical_management_of_insulinoma_ L2 - http://www.diseaseinfosearch.org/result/3837 DB - PRIME DP - Unbound Medicine ER -