ARTICOLE ORIGINALE - ORIGINAL PAPERS
PANCREATIC INSULINOMA
E. Târcoveanu, C. Lupascu, R. Moldovanu,
G. Dimofte, Oana Epure, Voichita Mogos*, Luiza Mitocaru*, C. Daniil**,
Niculina Florea***
First Surgical Clinic, Research Center for Laparoscopic and Classic
Surgery,
*Clinic of Endocrinology,
**Clinic of Radiology,
***Department of Morfopathology,
„St. Spiridon” University Hospital, University of Medicine
and Pharmacy Iasi
Jurnalul de chirurgie 2005; 1 (1):42-52
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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.
KEYWORDS: PANCREATIC INSULINOMA, PANCREATIC ENDOCRINE TUMOR
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