Endocrine Abstracts (2009) 20 P216

Insulinomas: experience of Coimbra's University Hospital, Endocrinology Department

Jacinta Santos, Isabel Paiva, Mariana Martinho, Alexandra Vieira & Manuela Carvalheiro

Endocrinology, Diabetes and Metabolism Department, University Hospital of Coimbra, EPE, Coimbra, Portugal.

Background: Insulinomas are rare neuroendocrine tumours (4 cases/million patients per year), representing an important cause of hyperinsulinemia. Usually are benign and sporadic, but can be part of multiple endocrine neoplasias. To establish the diagnosis it is essential to document inappropriately high levels of insulin during episodes of hypoglycaemia.

Aim: Retrospective analysis of the clinical files of the patients followed in our department since January 1997.

Patients and methods: The analysed parameters were: age, gender, clinical presentation, biochemical and imaging diagnosis, treatment and follow-up.

Results: We studied nine patients (5M: 4F), mean age 57.2±18.1 years old and body mass index 31.7±7.5 kg/m2. Six patients were symptomatic, all with neuroglicopenic symptoms, four of them also with adrenergic symptoms and one reporting increase of weight. Three patients were asymptomatic, but fasting hypoglicemias were detected in routine analysis. One patient was already diagnosed as MEN-1. Eight patients performed the 72-hours fasting test (minimum glicemia 31.9±6.0 mg/dl, insulinemia 15.7±7.2 μUI/ml and C peptide 4.2±2.3 ng/ml). Mean HbA1c was 4.8±0.6%. Tumour localization: pancreatic head (2), body (3), tail (2), body–tail transition (2). Mean diameter was 2.6±2.2 cm. Three patients were submitted to preoperative medical treatment with octreotide, and one of them also with diazoxide. Surgical procedures were the following: pancreaticoduodenectomy (1), tail pancreatectomy (1), body–tail pancreatectomy (4) and enucleation (3, one of them reoperated – partial pancreatectomy). There were several surgical complications: one ileum perforation and death, three pancreatic fistulas, one transverse colon perforation, two pseudocysts and one case of pancreatic abscess. Surgery was curative in all patients alive. Anyone developed diabetes.

Conclusions: The authors emphasize the serious difficulties in the diagnosis, namely the preoperative localization of the insulinoma, which sometimes is only recognized during surgery. Treatment is also a delicate matter, since these surgical procedures are extremely invasive, with a high level of complications.

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