Endocrine Abstracts

Backgraund: Insulinoma is the most common functional pancreatic neuroendocrine tumor originating from β-cells, with unregulated insulin production and rarely associated with MEN-I syndrome. Diagnosis and treatment of insulinoma are a challenge in the practice of endocrinologist.

Aim: To determine on the basis of retrospective analysis the optimal approaches to the management of patients with organic hyperinsulinism.

Materials and methods: Medical records of 72 patients admitted with suspected organic hyperinsulinism had been screened and medical histories of patients with a confirmed diagnosis of organic hyperinsulinism were included into the analysis. Anamnesis, results of objective, laboratory and instrumental examinations, methods and results of the treatment were analyzed.

Results: The diagnosis of insulinoma was confirmed in thirty two cases. Hypoglycemia was achieved within the first 48 h after the start of the 72-h fasting test in 100% of cases. Study results showed that in 50% of cases the size of the pancreatic neoplasm was more than 1.4 cm. Inverse correlation between tumor size and plasma glucose concentration at the time of hypoglycemia was found (r=−0.45, P=0.02). Surgical treatment was carried out in thirty out of 32 patients. Surgical enucleation of insulinoma was performed in 12 (40%) cases, distal pancreatectomy – in 18(60%). Insulinoma was confirmed in 27 cases, while in three patients diagnosis of non-insulinoma pancreatogenous hypoglycemia (‘nesidioblastosis’) was established according to histological findings. Positive clinical result was achieved after all surgeries. In postoperative period patients were discharged within 11–30 days. Patients without post-operative complications were discharged 13.0±1.4 days after surgery. Twelve (40%) patients developed post-operative complications. The duration of hospital stay in these cases was significantly longer 20.1±1.9 (P<0.01).

Conclusions: Obtained data confirmed that comprehensive approach including 72-h fasting test, use of modern imaging techniques and application of high-tech treatment methods, is crucial for successful diagnosis and treatment of insulinoma.