Insulinoma arising from the beta cells of islets is the most common functioning tumor of the pancreas, while its incidence is low in our country.
Insulinoma is characterized by a typical symptomatic attack caused by hypoglycemia and relief of symptoms by administraction of glucose.
We experienced 5 cases of insulinomas of pancreas during the last 4 years in our department. Now we are going to analyze retrospectively 23 cases of insulinoma including 18 cases reported in Korean Surgical Society since 1973.
1) The most prevalent age group was in the 6th decade and male to female ratio was 1:4.7.
2) The common clinical manifestations were neuroglycopenic symptoms (88.2%) and adrenergic symptoms (70.6%) such as loss of consciousness, weakness, sweating, confusion and seizure.
3) As a sensitive diagnostic modality prolonged fasting test (9 cases) predicted the tumor in all studied 9 cases. Glucose tolerance test showed the positive finding in 6 out of 7 cases, while glucagon stimulation test did not show ant
positivity
in 2
cases.
4) For the preoperative localization of the tumor, many diagnostic tools were used showing the sensitivity as such, EUSj (100% in 2 cases), THPVS (75% in 4 cases), selective angiography (62.5% in 16 cases), MRI (50% in 2 cases) and CT scan
(35.3%
in 17
cases).
5) As for the operative treatment, enucleation was done in 7 patients, distal pancreatectomy in 14 patients and pylorus preserving pancreaticoduodenectomy in 1 patient. Reoperation was done in two cases due to improper detection of primary
tumor.
6) The tumors were evenly distributed thoughout the pancreas such as head (31.8%), neck (13.6%), body (22.7%) and tail (31.8%). Most of the tumors were solitary (94%) and benign (97%) histologicaly. The mean size was 1.77 cm in diameter.
7) Regarding the postoperative complications, DM and pancreatic fistula were developed in 1 patient following subtotal resection as a secondary operation.
|