Original Research Article
Year: 2023 | Month: May | Volume: 10 | Issue: 5 | Pages: 5-12
DOI: https://doi.org/10.52403/ijrr.20230502
Insulinoma: Not Anymore, a Hidden Challenge
Gagan Soni1, Asma Khalife2, Anand R Duga2, Bhushan M Telang2, Deepak Ranveer2, Rajeev M. Joshi2
1Department of Surgical Disciplines, All India Institute of Medical Science, New Delhi, 110049, India
2Department of General Surgery, Topiwala National Medical College & Bai Yamunabai Laxman Nair Ch. Hospital, Mumbai, Maharashtra, India
Corresponding Author: Dr. Gagan Soni
ABSTRACT
Insulinomas comprise 1-2% of all pancreatic tumours and their small size coupled with non-specific symptomatology and an uncanny ability to go undetected on conventional imaging techniques makes preoperative localisation a diagnostic challenge. The objective is to evaluate the utility of imaging modalities and to analyse the presentation and surgical outcomes. Twenty consecutive operated cases of Insulinomas were reviewed retrospectively & prospectively over a 10year period from March 2011 to February 2021. Elevan were female & 9 male, median age was 37± 16.2 (range 21 to 50) years. The most common presentation was pre-prandial hypoglycaemia with symptomatic improvement on sugar ingestion. Biochemical diagnostic criteria used were, fasting blood glucose levels <50 mg/dl with synchronous insulin levels of >3.0 μU/ml and C-peptide levels of >0.6 ng/ml. Tumour localisation was done using a combination of CT, MRI and/or EUS in most patients and a Ga68-DOTATATE in some patients. The size ranged between 1-2 cm and their distribution was as follows: 10 in tail, 5 in body, 4 in the head of pancreas and 1 in the uncinate process. Enucleation was done in 12 patients and in 8 patients, distal pancreatectomy with/without splenectomy was done. All patients recovered uneventfully and were asymptomatic on an average follow-up of 2 years, except for one patient who developed a peripancreatic collection, detected 2 months after surgery and managed conservatively. Additionally, 2 patients had similar symptoms but were found to have nesidioblastosis and presacral soft tissue tumour.
Keywords: Insulinoma, Whipple’s triad, hypoglycaemia, neuroglycopenic symptoms, enucleation.
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