Chronologic Change of Hyperinsulinemic Hypoglycemic Disease-insulinoma and Nesidioblastosis in 64 Patients.
- Author:
Jung Woo LEE
1
;
Song Chael KIM
;
Duck Jong HAN
Author Information
1. Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Korea. djhan@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Insulinoma;
Hyperinsulinemic hypoglycemia;
Nesidioblastosis
- MeSH:
Angiography;
Calcium;
Cohort Studies;
Early Diagnosis;
Endosonography;
Humans;
Incidence;
Insulinoma;
Magnetic Resonance Imaging;
Multiple Endocrine Neoplasia Type 1;
Nesidioblastosis;
Palpation;
Pancreatectomy;
Pancreaticoduodenectomy;
Retrospective Studies;
Tomography, Spiral Computed
- From:Korean Journal of Hepato-Biliary-Pancreatic Surgery
2009;13(4):275-285
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Insulinomas and nesidioblastosis are surgically curarable hyperinsulinemic hypoglycemic diseases; however the symptoms, diagnosis, and localization of these diseases are sometimes difficult. METHODS: From April 1990 to December 2008, patients with diagnosis of pancreatic insulinoma and nesidioblastosis were retrospectively reviewed. RESULTS: In the entire cohort, there were 6 patients with multiple endocrine neoplasia type 1 (MEN 1), 7 patients with nesidioblastosis, and 7 patients with multiple lesions. The incidence of neuroglycopenic symptoms (71.5%) was more prevalent than autonomic symptoms (26.5%). The pre-operative localization methods were computed tomography (CT), transabdominal ultrasonography, endoscopic ultrasonography (EUS), magnetic resonance imaging (MRI), angiography, selective arterial calcium stimulation with venous sampling (ASVS), and transhepatic portal venous sampling (THPVS) which had sensitivities of 75%, 40%, 75%, 64%, 48%, 20%, and 87%, respectively. During the second half of the study period, CT had a sensitivity of 83%. THPVS was the most sensitive method of all the diagnostic tools. Intra-operative palpation and ultrasonography were the most powerful modalities for tumor localization. The surgical treatments included enucleation (20%), distal pancreatectomy (51%), central pancreatectomy (12%), pancreaticoduodenectomy (15%), and near-total pancreatectomy (1.5%). From 2006, laparascopic surgery was used as the preferred treatment modality for insulinomas. CONCLUSION: Early diagnosis and precise localization is the most important aspect of treating insulinomas. For better localization, dual phase spiral CT and intra-operative ultrasonography play an important role in tumor localization.
