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2015, Number 2

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Rev Med MD 2015; 6.7 (2)

Insulinoma: review of current management and treatment

Medina-Zamora P, Lucio-Figueroa JO

Language: Spanish
References: 51
Page: 83-90
PDF size: 679.49 Kb.


ABSTRACT

Insulinoma is a rare of the pancreatic islets cell tumor characterized by an overproduction of insulin with hypoglycemia. The tumor incidence is 3-10 cases per million inhabitants. The average age of onset ranges from 40 to 50 years and is most common in women. They are usually small and benign tumors in 90%, normally measuring less than 2 cm. 90% are sporadic and only 10% are associated with MEN-1 syndrome. Symptoms are related to the development of hypoglycemia and patients often experience adrenergic discharge manifestations (anxiety, weakness, sweating, and palpitations) and symptoms associated to neuroglycopenia (headache, diplopia, blurred vision, loss of consciousness, seizures). Symptoms are present up to 24 months before diagnosis. The diagnosis of insulinoma is made biochemically in most cases with low levels of blood glucose, high insulin levels, C-peptide and proinsulin during a spontaneous hypoglycemia test or 72 hour fasting exam under strict supervision. The location of the tumor may be confirmed using computed tomography, magnetic resonance imaging, endoscopic or transabdominal ultrasound. Sometimes additional tests and examinations are required if tumor localization is impossible by conventional techniques.
Definitive treatment is based on surgical resection of the tumor. Enucleation is reserved only for benign and small tumors. Meanwhile, pancreatectomy is used for the rest of them. Laparoscopic surgery is now widely being used for the treatment of this type of tumors. . The cure rate using surgical resection is nearly 100%. Medical treatment is reserved for non-resectable tumors and patients not eligible for surgery.


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