title: Insulinoma: Diagnosis and surgical treatment. Retrospective analysis of 31 cases.
abstract: BACKGROUND
  Insulinomas are rare tumors that are usually benign, single and curable by simple surgical excision. They can present problems in diagnosis and localization.
  
  
  METHODS
  Retrospective analysis of patients with insulinoma managed during a 13-year period (1992-2005) at a tertiary-level institution.
  
  
  RESULTS
  31 patients (mean age 38.4 [SD 13.3] years; 16 men) presented with hypoglycemic symptoms for 4.6 (5.5) years. In 22 (71%) patients, the lesion was successfully localized pre-operatively. Of various pre-operative localization techniques, CT angiography (5/6; 83%), intra-arterial digital subtraction angiography (11/17; 65%), dual-phase CT (8/14; 57%) and conventional MRI (4/13; 31%) had high rates of successful tumor localization. Intra-operative palpation and ultrasonography also had localization success rates (22/30 [76%] and 11/12 [92%], respectively); each identified one lesion that the other procedure did not localize. Of the 30 patients who underwent surgery, 28 had solitary tumor.
  
  
  CONCLUSIONS
  Pre-operative investigations to localize insulinoma are helpful despite the availability of intra-operative ultrasound. Dual-phase CT should be the non-invasive investigation of first choice.
authors.affiliation: Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi 110 029, India. vivekapjyotsna@yahoo.com
authors.forename: Viveka P
authors.initials: VP
authors.lastname: Jyotsna
authors.forename: Neil
authors.initials: N
authors.lastname: Rangel
authors.forename: Sujoy
authors.initials: S
authors.lastname: Pal
authors.forename: Ashu
authors.initials: A
authors.lastname: Seith
authors.forename: Peush
authors.initials: P
authors.lastname: Sahni
authors.forename: A C
authors.initials: AC
authors.lastname: Ammini
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007340:Insulinoma / Q000175:diagnosis* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome