Endogenous hyperinsulinemic hypoglycemia syndrome: surgical treatment.
BACKGROUND
The endogenous hyperinsulinemic hypoglicemia syndrome (EHHS) can be caused by an insulinoma, or less frequently, by nesidioblastosis in the pediatric population, also known as non insulinoma pancreatic hypoglycemic syndrome (NIPHS) in adults. The aim of this paper is to show the strategy for the surgical treatment of ehhs.


METHODS
A total of 19 patients with a final diagnosis of insulinoma or NIPHS who were treated surgically from january 2007 until june 2012 were included. We describe the clinical presentation and preoperative work-up. Emphasis is placed on the surgical technique, complications and long-term follow-up.


RESULTS
All patients had a positive fasting plasma glucose test. Preoperative localization of the lesions was possible in 89.4% of cases. The most frequent surgery was distal pancreatectomy with spleen preservation (9 cases). Three patients with insulinoma presented with synchronous metastases, which were treated with simultaneous surgery. There was no perioperative mortality and morbidity was 52.6%. Histological analysis revealed that 13 patients (68.4%) had benign insulinoma, 3 malignant insulinoma with liver metastases and 3 with a final diagnosis of SHPNI. Median follow-up was 20 months. All patients diagnosed with benign insulinoma or NIPHS had symptom resolution.


CONCLUSIONS
The surgical treatment of EHHS achieves excellent long-term results in the control of hypoglucemic symptoms.
Sector de Cirugía Hepato-Bilio-Pancreática y Trasplante Hepático, Departamento de Cirugía General, Hospital Italiano de Buenos Aires (HIBA), Buenos Aires, Argentina. Electronic address: martin.desantibanes@hospitalitaliano.org.ar.
Martín
M
de Santibañes
Sector de Cirugía Hepato-Bilio-Pancreática y Trasplante Hepático, Departamento de Cirugía General, Hospital Italiano de Buenos Aires (HIBA), Buenos Aires, Argentina.
Agustín
A
Cristiano
Sector de Cirugía Hepato-Bilio-Pancreática y Trasplante Hepático, Departamento de Cirugía General, Hospital Italiano de Buenos Aires (HIBA), Buenos Aires, Argentina.
Oscar
O
Mazza
Sector de Endocrinología, Departamento de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Luis
L
Grossenbacher
Sector de Cirugía Hepato-Bilio-Pancreática y Trasplante Hepático, Departamento de Cirugía General, Hospital Italiano de Buenos Aires (HIBA), Buenos Aires, Argentina.
Eduardo
E
de Santibañes
Sector de Cirugía Hepato-Bilio-Pancreática y Trasplante Hepático, Departamento de Cirugía General, Hospital Italiano de Buenos Aires (HIBA), Buenos Aires, Argentina.
Rodrigo
R
Sánchez Clariá
Sector de Cirugía Hepato-Bilio-Pancreática y Trasplante Hepático, Departamento de Cirugía General, Hospital Italiano de Buenos Aires (HIBA), Buenos Aires, Argentina.
Enrique
E
Sivori
Sector de Angiografía y Radiología Intervencionista, Departamento de Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Ricardo
R
García Mónaco
Sector de Cirugía Hepato-Bilio-Pancreática y Trasplante Hepático, Departamento de Cirugía General, Hospital Italiano de Buenos Aires (HIBA), Buenos Aires, Argentina.
Juan
J
Pekolj
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006946:Hyperinsulinism / Q000150:complications / Q000601:surgery*; D007003:Hypoglycemia / Q000209:etiology / Q000601:surgery*; D007340:Insulinoma / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D013577:Syndrome; D055815:Young Adult
Endogenous hyperinsulinism; Hiperinsulinismo endógeno; Hipoglucemia; Hypoglycemia; Insulinoma; Nesidioblastosis; Pancreas neoplasm; Tumores de páncreas