Surgical treatment of persistent hyperinsulinemic hypoglycemia (PHH) (insulinoma and nesidioblastosis).
BACKGROUND
The persistent hyperinsulinemic hypoglycemia is characterized by clinical symptoms that occur when the blood glucose levels drop below the normal range. Two pathological situations cause this clinical problem: The presence of a tumor of the pancreas secreting excessive amounts of insulin, known as insulinoma, and congenital beta-cell hyperplasia in the pancreas in children and noninsulinoma pancreatogenic hypoglycemia syndrome in adults.


METHODS
Clinical characteristic and surgical outcome of a group of 20 patients operated on for this hypoglycemic syndrome; 18 for insulinoma and two for nesidioblastosis in children was studied.


RESULTS
eight of the insulinomas were in the head of the pancreas, two in the body, and the remaining eight in the tail. The surgical technique was enucleation in nine cases, local resection in one case because of suspicious malignancy, and distal pancreatectomy in eight cases. Both children with nesidioblastosis underwent 85% pancreatectomy with splenic preservation. There was no mortality in the study, but three patients developed a low-volume pancreatic fistula after head enucleation.


CONCLUSIONS
Negative results in diagnostic localization together with the small size of the insulinoma represent a poor combination for successful surgery. The intraoperative ultrasonography is the method of choice for the identification of the tumor, as it is able to identify nonpalpable lesions.
Casanova
Daniel
D
Department of General Surgery, University Hospital Marqués de Valdecilla, University of Cantabria, 39008 Santander, Spain. casanovd@unican.es
Polavieja
Manuel G
MG
Naranjo
Angel
A
Pardo
Fernando
F
Rotellar
Fernando
F
Gonzalez
Francisco
F
Luzuriaga
Cristina
C
Regaño
Sara
S
Freijanes
Julio
J
D000328:Adult; D000368:Aged; D044903:Congenital Hyperinsulinism / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006801:Humans; D006946:Hyperinsulinism / Q000175:diagnosis / Q000601:surgery*; D007223:Infant; D007340:Insulinoma / Q000175:diagnosis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D018761:Multiple Endocrine Neoplasia Type 1 / Q000175:diagnosis / Q000601:surgery*; D046768:Nesidioblastosis / Q000175:diagnosis / Q000601:surgery*; D010180:Pancreatectomy / Q000379:methods; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology