Insulinoma: Diagnosis and surgical treatment. Retrospective analysis of 31 cases.
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.
Jyotsna
Viveka P
VP
Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi 110 029, India. vivekapjyotsna@yahoo.com
Rangel
Neil
N
Pal
Sujoy
S
Seith
Ashu
A
Sahni
Peush
P
Ammini
A C
AC
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