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Abstract : |
The incidence of insulinomas is very low. Despite their usual small size they may induce serious complications. Once the clinical and biological diagnosis is established, the localization of the tumor can be a difficult task and a large number of diagnostic procedures has been used to substantiate such small lesions: selective arterial stimulation and hepatic venous sampling, arteriography, computed tomography, magnetic resonance imaging, laparoscopic ultrasonography. A total of four cases of insulinoma (all females) are presented in which the diagnosis was delayed by two to five years due to misinterpretation of neurological symptoms generated by hypoglycemia. The diagnosis of insulinoma was based on high plasma insulin levels associated with low plasma glucose levels, as well as the symptomatic relief after intravenous glucose injection. The surgical option was based on biological data, ultrasonography, computed tomography and arteriography. In one case the localization of the insulinoma was established only by intraoperative ultrasonography. All tumors were localized in the tail of pancreas. In three cases we decided for a distal pancreatic resection with splenectomy and in one case for hemipancreatectomy with spleen preservation. Postoperative course was uneventful and all the symptoms disappeared. The diagnosis was confirmed on pathological examination in all cases. Conclusions: Surgical removal of insulinomas is the best treatment. Open pancreatic surgery for endocrine tumors is associated with a high morbidity rate. , |
