Endocrine Abstracts (2006) 11 P476

Diagnosis difficulties in insulinomas

AE Ranetti, A Mazilu, C Spiroiu & A Mihai


Central Military Hospital, Bucharest, Romania.


We have studied 5 cases of insulinomas presented in our clinic in 2004–2005 with typical signs and symptoms of hypoglycemia correlated with high insulinemia. The medium insulin value in the morning was 57.9 mUI/ml, but we found values ranging from 10–98 mUI/ml for medium and severe hypoglycemia. There was no correlation between severity of hypoglycemia and insulin level, proven by repeated insulin dosages.

The purpose of our analysis was to identify the best-suitable diagnosis imaging methods for location of insulinomas, by comparing abdominal ultrasonography, CT, MRI and echographic endoscopy.

None of the cases had shown positive results on abdominal (pancreatic) ultrasound.

Four of the cases had negative abdominal CT scan, in one of this cases the tumor was identified on MRI abdominal scan, with 1.2 cm diameter, but all of them were visualized using echoendoscopy.

The fifth case who underwent a previous unsuccessful pancreatic resection for insulinoma had negative abdominal MRI, CT scan, echoendoscopy, with high level insulinemia and metastatic lesions in the liver found on echoendoscopy. Selective celiac artery catheterization shown tumor in second part of duodenum. All tumors were successfully operated.

Conclusions: Repeated insulin dosage is necessary to confirm insulinoma as well as multiple imaging methods. Echoendoscopy is still the gold standard for insulinoma detection, CT and MRI are useful in planning the surgery by indicating the exact location regarding the adjacent structures.

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