Insulinoma is a functional endocrine tumor arising from the beta cells of islets of Langerhans of pancreas. The only effective treatment of insulinoma was surgical removal of the tumor. Recently, laparoscopic surgery for islet cell tumors of the pancreas is introduced. Laparoscopic enucleation or resection of benign islet tumors results in a shorter hospital recovery and is a good alternative to open surgery We report a case of insulinoma that was treated sucessfully by laparoscopic enucleation.
Adenoma, Islet Cell ; Insulinoma* ; Islets of Langerhans ; Laparoscopy ; Pancreas

Hyperinsullinism and the resultant hypoglycemia are hallmarks of functioning beta islet cell tumors of the pancreas. The management of one case of insulinoma during surgery for the removal of the tumor is described and the available literature on the subject reviewed. The outline of the anesthetic management for the insulinoma is as follows: 1) Anesthetists should understand the signs and the symptoms of hypoglycemia and hyperglycemia. 2) Preoprative management: a) infusion of glucose for avoiding hypoglycemia due to NPO after midnight. b) glucocorticosteroid administration with premedications. 3) Operative management: a) continuous determination of blood glucose level may be helpful. b) Maintenance of the glucose level about 50mg% above symptomatic CNS level have the advantage that exicision of the infulinoma can be immediately judged. c) The use of an agent that decreases CMRO2 and does not affect the insulin-glucose ratio is rational choice when concern about hypoglycemia exists. Thiopental-enflurane anesthesia with controlled ventilation maintaining normocarbia is recommended. d) beta-adrenergic blocker. These drugs must be avoided in the hypoglycemic state.
Adenoma, Islet Cell ; Anesthesia ; Blood Glucose ; Glucose ; Hyperglycemia ; Hypoglycemia ; Insulinoma ; Pancreas ; Premedication ; Ventilation

Insulinoma is rare functioning islet cell tumor of pancreas and its main feature is frequent attacks of hypoglycemia. Because of frequent seizure, the disease is occasionally mistook as epilepy. We experienced a case of insulinoma with dilantin toxicity in a 45 year old patient who had been treated with dilantin for 7 years. Selective splenic arteriogram showed 0.8cm mass in the tail of pancreas which was proven insulin secreting tumor on histiopathological examination. After operation no more seizure attack was detected and her blood sugar level was well maintained within normal range. This case might provide an insight that the possibility of insulinoma should be considered in patient with episodic neurobehavioral dysfunction such as epilepsy.
Adenoma, Islet Cell ; Blood Glucose ; Epilepsy ; Humans ; Hypoglycemia ; Insulin ; Insulinoma ; Pancreas ; Phenytoin ; Reference Values ; Seizures ; Tail

Two patients with clinical and biochemical evidences of islet cell hyperfunction underwent percutaneous transhepatic portal and pancreatic vein catheterization and hormone assays. Local step-ups of insulin level in the protal venous system, found in two patients with insulinoma, corresponded to tumor sites at surgery. One patients had single insulinoma and the other had malignant insulinoma and liver metastasis. Percutaneous transhepatic protal and pancreatic vein catheterization with measurement of radioimmunoactive insulin concentration is a safe and reliable method, and may play an important role in the localization of adenoma in patients with hyperinsulinism.
Adenoma ; Adenoma, Islet Cell* ; Catheterization ; Catheters ; Diagnosis* ; Humans ; Hyperinsulinism ; Insulin ; Insulinoma ; Islets of Langerhans* ; Liver ; Methods ; Neoplasm Metastasis ; Veins

Two patients with clinical and biochemical evidences of islet cell hyperfunction underwent percutaneous transhepatic portal and pancreatic vein catheterization and hormone assays. Local step-ups of insulin level in the protal venous system, found in two patients with insulinoma, corresponded to tumor sites at surgery. One patients had single insulinoma and the other had malignant insulinoma and liver metastasis. Percutaneous transhepatic protal and pancreatic vein catheterization with measurement of radioimmunoactive insulin concentration is a safe and reliable method, and may play an important role in the localization of adenoma in patients with hyperinsulinism.
Adenoma ; Adenoma, Islet Cell* ; Catheterization ; Catheters ; Diagnosis* ; Humans ; Hyperinsulinism ; Insulin ; Insulinoma ; Islets of Langerhans* ; Liver ; Methods ; Neoplasm Metastasis ; Veins

Insulinomas are the most common type of islet cell tumor. Generally, these tumors are benign (90%), intrapancreatic, solitary, and small (measuring less than 2 cm), and they occur throughout the head, body, and tail of the pancreas with equal frequency. The methods for diagnosing an insulinoma involve whipples triad and biochemical test by a monitored 72-hour test. The diagnosis is obtained by blood for glucose and insulin, C-peptide samples taken every 4 to 6 hours during the test, particularly when symptoms develop, and calculation of the insulin to glucose ratio. Preoperative radiographic localization of islet cell tumors in patients with insulinomas is important to remove the tumor adequately. A 43-year-old man with dizziness, sweating, and loss of consciousness twice in a period of 2 years was hospitalized with clinical suspicion of an insulinoma. The findings of computed tomography,and transabdominal and endoscopic ultrasonography were all negative. Transhepatic venous sampling for a pancreatic hormone assay showed a sudden increase in the insulin level in the proximity of the head of the pancreas, however, this was not localized correctly. We report a case where insulin was found in the tail of the pancreas, as confirmed by CT-angiography , and we present a review of literature.
Adenoma, Islet Cell ; Adult ; C-Peptide ; Diagnosis ; Dizziness ; Endosonography ; Glucose ; Head ; Humans ; Insulin ; Insulinoma* ; Pancreas ; Sweat ; Sweating ; Unconsciousness

Hyperinsulinism caused by a functioning islet cell tumor of the pancreas is an uncommon but well established metabolic entity which can usually be diagnosed accurately. We treated a patient with functioning insulinoma recently. The outline of the particular management given for the course of the anesthesia of the patient was as follows: 1) Control of blood glucose a) pre- and intraoperative hypoglycemia; Glucose was administered through intravenous drip or orally. b) postoperative transient hyperglycemia; Insulin was administered if necessary and a small amount of glucose uptake, occurred. 2) Anesthetics, and supplemental drugs Drugs with no or little effect in increasing blood glucose were used. 3) Beta-adrenergic blockers These drugs were not used in the hypoglycemic state because of potentiating insulin activity.
Adenoma, Islet Cell ; Adrenergic beta-Antagonists ; Anesthesia* ; Anesthetics ; Blood Glucose ; Glucose ; Humans ; Hyperglycemia ; Hyperinsulinism ; Hypoglycemia ; Infusions, Intravenous ; Insulin ; Insulinoma* ; Pancreas

We present the cytologic features of a case of solid and papillary neoplasm of the pancreas. Cytologically, the tumor was composed of a monotonous population of polygonal cells containing eccentrically located round nuclei with one or two distinct small nucleoli and a finely stippled chromatin pattern. The tumor cells were similar to those of the islet cell tumor and showed isolated loosely aggregated and solid sheets or large cell clumps. The large cell clumps revealed a branching papillary structure containing fibrovascular central core, which is characteristic histologic feature of solid and papillary neoplasm of the pancreas. This case was confirmed by tissue examination including histochemical, immunohistochemical and electron microscopical studies. Ultrastructurally, the tumor cells contained a few membrane-bound electron dense granules.
Adenoma, Islet Cell ; Chromatin ; Pancreas ; Urinary Tract*

Insulinoma is a rare tumor, occurring more often in women and in the older age range. Eighty percent of patients have a single benign tumor, usually 2 cm in diameter, located with about equal frequency in body, head or tail of pancreas and amenable to surgical cure. About 10% have multiple tumors. The remaining 10% of patients have metastatic malignant insulinoma. The symptom of insulinoma is characterized by the periodic attack of hypoglycemia of blood sugar level below 50mg%, by fasting or exertion, and rapid relief of symptom by oral or intravenous administration of glucose. Symptom often lead to misdiagnosis as a neurologic or psychiatric disorder. A case described by authors was 44-year old female with the chief complaints of the loss of consciousness, epileptic seizure although she has been treated by anticonvulsants. Serum blood sugar and insulin level during fasting suggested insulinoma but abdominal computed tomography shows no definitive mass in pancreas. Celiac angiography revealed insulinoma. She transferred to the department of General Surgery and was performed enucleation. Microscopic findings shows the islet cell tumor of pancreas. A brief review of the literature was made.
Adenoma, Islet Cell ; Administration, Intravenous ; Angiography ; Anticonvulsants ; Blood Glucose ; Diagnostic Errors ; Epilepsy ; Fasting ; Female ; Glucose ; Head ; Humans ; Hypoglycemia ; Insulin ; Insulinoma* ; Pancreas ; Tail ; Unconsciousness

Insulinomas are the most common type of islet cell tumor. Generally, these tumors are benign (90%), intrapancreatic, solitary, and small. Moreover, hyperinsulinemia in infants and children can result in permanent damage to the central nervous system. Thus, early diagnosis and treatment are important. The principal challenge during anesthesia is the avoidance of hypoglycemia, which may occur during tumor manipulation, though hyperglycemia may follow after successful surgical removal of the tumor. Because symptoms of hypoglycemia (systemic hypertension, tachycardia, diaphoresis) may be masked during anesthesia, it is important to monitor blood glucose levels frequently during the perioperative period. Here we report up on the case of a 3 year old female with insulinoma. We monitored blood glucose levels intermittently (about every 15 minutes) using a glucometer (Medisense Optium, Abbott, USA). No hypoglycemic episode occurred during anesthesia. We report this clinical experience and review anesthetic choices and the management of this patient.
Adenoma, Islet Cell ; Anesthesia ; Blood Glucose ; Central Nervous System ; Child ; Child, Preschool ; Early Diagnosis ; Female ; Humans ; Hyperglycemia ; Hyperinsulinism ; Hypertension ; Hypoglycemia ; Infant ; Insulinoma* ; Isoflurane ; Masks ; Pancreas ; Perioperative Period ; Tachycardia