title: Insulinoma: a multicenter, retrospective analysis of three decades of experience (1983-2014).
abstract: OBJECTIVE
  To analyze the clinical features, diagnostic procedures, treatment, and clinical outcome of insulinomas diagnosed and treated in the period 1983-2014 in four Spanish hospitals.
  
  
  METHODS
  All patients with either biochemical and morphological criteria of insulinoma and/or histological demonstration of insulin-secreting tumor were included.
  
  
  RESULTS
  Twenty-nine patients [23 women (79.3%); mean age 48.7±17.4 years (range, 16-74)] were recruited. Twenty-six patients (89.7%) had sporadic tumors, and the rest (3 women, 10.3%) developed in the context of multiple endocrine neoplasia type 1. There were 3 (10.3%) multiple insulinomas, one associated with multiple endocrine neoplasia type 1, and two (6.9%) malignant insulinomas, both sporadic. Most patients (n=18, 62.1%) had fasting hypoglycemia, about a third (31%) both postprandial and fasting hypoglycemia, and 6.9% postprandial hypoglycemia only. Time to glucose nadir (37.3±6.5mg/dL) in the fasting test was 9.0±4.4h, with maximal insulin levels of 25.0±20.3μU/mL. Abdominal CT detected insulinoma in 75% of patients. Twenty-seven (93.1%) patients underwent surgery [enucleation, 18 (66.7%) and subtotal pancreatectomy, 9 (33.3%); tumor size, 1,7±0,7cm]. Surgery achieved cure in the majority (n=24, 88.9%) of patients.
  
  
  CONCLUSIONS
  In our setting, insulinoma is usually a benign, small, and solitary tumor, mainly affecting women aged 45-50 years, and usually localized with abdominal CT. The most commonly used surgical technique is enucleation, which achieves a high cure rate.
authors.affiliation: Servicio de Endocrinología y Nutrición, Hospital Ramón y Cajal, Madrid, España. Electronic address: piglo65@gmail.com.
authors.forename: Pedro
authors.initials: P
authors.lastname: Iglesias
authors.affiliation: Servicio de Endocrinología y Nutrición, Hospital Ramón y Cajal, Madrid, España.
authors.forename: Christian
authors.initials: C
authors.lastname: Lafuente
authors.affiliation: Servicio de Endocrinología y Nutrición, Hospital Virgen de la Concha, Zamora, España.
authors.forename: María Ángeles
authors.initials: MÁ
authors.lastname: Martín Almendra
authors.affiliation: Servicio de Endocrinología y Nutrición, Hospital Nuestra Señora de Sonsoles, Ávila, España.
authors.forename: Antonio
authors.initials: A
authors.lastname: López Guzmán
authors.affiliation: Servicio de Endocrinología y Nutrición, Hospital General, Segovia, España.
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Castro
authors.affiliation: Servicio de Endocrinología y Nutrición, Hospital Ramón y Cajal, Madrid, España; Departamento de Medicina, Universidad de Alcalá de Henares, Madrid, España.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Díez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D002096:C-Peptide / Q000097:blood; D005215:Fasting / Q000097:blood; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000209:etiology; D007340:Insulinoma / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018761:Multiple Endocrine Neoplasia Type 1 / Q000453:epidemiology; D010180:Pancreatectomy / Q000379:methods; D010190:Pancreatic Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D019518:Postprandial Period; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D047368:Tumor Burden; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D002096:C-Peptide
keywords: Insulinoma; Multicenter; Multicéntrico; Multiple endocrine neoplasia; Neoplasia endocrina múltiple; Retrospective; Retrospectivo