Endocrine Abstracts

Introduction: Insulinomas are usually singular adenomas <1 cm. Less than 5% have diameter >3 cm. Multiple adenomas frequency is estimated on 3 do 9%. Malignant insulinomas are diagnosed in 3–6% patients. The oldest patient with insulinoma described in literature was 95 years old. About 30–50% of patients are previously misdiagnosed.

Aim of the study: The aim of the study was presentation of patients with rare clinical characteristics of insulinoma.

Material and Methods: 4 patients, (2F; 2M), aged 45–94, mean 59.7±23.2 years were treated in 2003. Analysis of clinical picture and biochemical and visual investigations have been performed.

Results: Duration of symptoms varied from 5 to 9 years (mean 7.5±1.7) before diagnosis was established. The mean BMI value for the whole group was estimated as 29.0 kg/m². The lowest glycaemia in particular patients ranged from 18 to 29 mg% (mean 22.0±5.3) and HbA_1C from 4.0 to 4.2% (mean 4.1±0.1). The serum insulin measured during hypoglycaemia <45mg% was 4.3–13, mean 9.0±3.6 μIU/ml (normal range 0); C peptide – 0.78–3.5, mean 1.9±1.3 ng/ml. In 1 pts tumour was detected by CT (Ø −3 cm), in others by endoscopic ultrasound. 3 of pts were operated, 1 woman (94 y) died from pneumonia. Tumours were solitary in 3 cases, in 1 – double. MEN1 was recognised in none case.

Summary: Our study group was consisted of the following patients: 1 patient with tumour with 3 cm in diameter, 1 with double as well as malignant tumour, 1 patient was 94 years old. One patient was previously misdiagnosed and treated for 8 years for an epilepsy.

Conclusion: Every patient has been characterized by at least one very rare and unusually occurred clinical feature in comparison with typical clinical picture.