| Summary: | Background/Aim. Insulinomas are rare benign tumors in the most cases and the
most frequent endocrine tumors of the pancreas. A wide spectrum of clinical
manifestations in patients with insulinoma is the reason for difficult
recognition of the disease with a long period of time between the onset of
symptoms and the diagnosis. Diagnostic procedures include Whipple’s triad,
72-hour fast test and topographic assessment. The only currative therapy for
patients with insulinoma is operative treatment. Methods. This retrospective
study included 42 patients with diagnosis of insulinoma treated in our
institution in a 60-year period. In all the patients a demographic and
clinical data, types of biochemical methods for diagnosis, and diagnostic
procedures for insulinoma localization were analyzed. Tumor size and
localization, surgical procedures, postoperative complications and outcome
were assessed. Results. A study included 42 patients, 29 women and 13 men.
The median age at diagnosis was 43 years. Median time between the onset of
symptoms and diagnosis was 3 years. The most common clinical symptoms and
signs were disturbance of consciousness and abnormal behavior in 73%,
confusion and convulsions in 61% of patients. The diagnosis of insulinoma was
estimated by Whipple's triad and 72-hour fast test in 14 patients.
Determination of insulinoma localization was assessed by angiography in 16
(36%) of the patients, by ultrasound (US) in 3 of 16 (18.8%) patients, by
abdominal computed tomography (CT) in 8 of 18 (44.5%) patients, and magnetic
resonance imaging (MRI) in 2 of 8 (25%) patients. Insulinoma was found in 13
of 13 (100%) patients by arterial stimulation with venous sampling (ASVS) and
in 13 of 14 (93%) patients by endoscopic ultrasound (EUS). Of the 42
patients, 38 (90.5%) underwent operative procedure. Minimal resection was
performed in 28 (73.6%) of the patients [tumor enucleation in 27 (71%) and
central pancreatectomy in one (2.6%) of the patients], and the major
resection was performed in 9 (23.6%) of the operated patients [distal
splenopancreatectomy in 8 (21%) and pancreaticoduodenectomy in one (2.6%)
patient]. The overall mortality rate in postoperative period was 2.6% (one
patient). Conclusion. A combination of ASVS and EUS as diagnostic procedures
ensures high accuracy for preoperative determination of insulinoma
localization. Minimal resection such as enucleation shoud be performed
whenever it is possible.
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