Clinical profile of insulinoma: analysis from a tertiary care referral center in India.
OBJECTIVE
To describe the clinical presentation, localization techniques, surgical procedures and outcome in patients with insulinoma.


METHODS
Retrospective analysis of case records of patients diagnosed with insulinoma between January 1993 and June 2009 at a tertiary-care hospital was done. Seventeen patients underwent diagnostic 72-h fast. The sensitivity of computed tomography (CT) of pancreas was judged using intraoperative findings as the gold standard.


RESULTS
Twenty-six patients (19 women) with mean age 42.2 years (median age 39.5 years) with biochemical/imaging evidence of insulinoma were included. All patients who underwent 72-h fast developed symptomatic hypoglycemia within 48 h. The sensitivity and positive predictive value (PPV) of CT of pancreas was 68.4% and 92.8%, respectively. Twenty patients underwent surgery, of whom four were operated on without preoperative localization. Four patients had recurrence of symptoms. Of the six patients who were not operated upon, the lesion was localized in four.


CONCLUSIONS
This audit shows that all patients with insulinoma develop hypoglycemia within 48 h of fasting. CT of pancreas localizes the lesion in two thirds of cases and would be a useful initial investigation in patients with suspected insulinoma.
Department of Endocrinology, Seth G S Medical College and KEM Hospital, Parel, Mumbai 400 012, India. drrajugopal@gmail.com
Raju A
RA
Gopal
Shrikrishna V
SV
Acharya
Sunil K
SK
Menon
Tushar R
TR
Bandgar
Padma S
PS
Menon
Nalini S
NS
Shah
D000328:Adult; D005260:Female; D006801:Humans; D007194:India; D007340:Insulinoma / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D011859:Radiography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity