title: [Diagnosis and treatment of pancreatic insulinoma].
abstract: BACKGROUND
  insulinoma is the most frequent pancreatic endocrine tumor. Its preoperative diagnosis has been controversial for many years. The aim of this study was to evaluate the experience in the management and treatment of this kind of tumor at Hospital Ramón y Cajal.
  
  
  METHODS
  between January 1999 and July 2006, 12 patients were operated on in our hospital (9 females and 3 males) who had been diagnosed with insulinoma, with a mean age of 56 years (16-72 years).
  
  
  RESULTS
  octreotide scintigraphy allowed a diagnosis in 33.3% of cases, abdominal CT in 83.3%, and echoendoscopy in 100%. Intraoperative ultrasonography confirmed the presence of an insulinoma in 100% of cases. In all cases a complete excision was possible, with 9 enucleations and 3 distal pancreatectomies. Two patients developed a pancreatic fistula, and one a pancreatic pseudocyst that healed spontaneously without surgery. The overall cure rate was 100%. After a mean follow-up of 48 months no recurrences have been reported.
  
  
  CONCLUSIONS
  in our experience, we consider advisable that abdominal CT and echoendoscopy be performed before surgery. However, the initial procedure of choice would be pancreas palpation and intraoperative ultrasonography. Surgery cured 100% of cases, and the procedure selected depends on size, location, distance from the main pancreatic duct, and relation to multiple endocrine neoplasm 1 (MEN-1).
authors.affiliation: Departamento de Cirugía General y Digestivo, Hospital Ramón y Cajal, Madrid, Spain. papriego@hotmail.com
authors.forename: P
authors.initials: P
authors.lastname: Priego
authors.forename: A
authors.initials: A
authors.lastname: Sanjuanbenito
authors.forename: E
authors.initials: E
authors.lastname: Martínez Molina
authors.forename: E
authors.initials: E
authors.lastname: Lobo
authors.forename: D
authors.initials: D
authors.lastname: García Teruel
authors.forename: V
authors.initials: V
authors.lastname: Morales
authors.forename: G
authors.initials: G
authors.lastname: Rodríguez
authors.forename: V
authors.initials: V
authors.lastname: Fresneda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007340:Insulinoma / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000601:surgery*