Unbounded Medicine

Insulinoma
The classic clinical manifestations are the Whipple’s triad (hypoglycemia, CNS dysfunction & revert of CNS dysfunction due to glucose administration) in 75% of patients.

Its incidence: This tumors are so rare. Probably the best series of insulinomas is from the Olmsted County (Mayo Clinic). This study (cohort) was seen over a sixth decade period (’27 to ‘86). The incidence there was 0.4 per 100,000 person-years (or four cases per million per year).

The diagnosis: Is established by demonstrating inappropriately high serum insulin concentrations during a spontaneous or induced episode of hypoglycemia. Then imaging techniques are used to localize the tumor. The available procedures include spiral CT, arteriography, ultrasonography (transabdominal and endoscopic), and 111-In-pentetreotide imaging. Transabdominal ultrasonography is our preferred initial test.

Its treatment: The treatment of choice is surgical removal of the insulinoma (enucleation of the tumor, distal pancreatectomy, whipple procedure, total pancreatectomy.