Adenoma of Pancreatic Islet Cells With Hypoglycemia and Hyperinsulinism

Abstract

Shortly after Banting and Best's discovery of insulin (1), Harris (10) in 1924, on the basis of cases of hypoglycemia with symptoms similar to those of insulin shock and relievable by feeding, postulated the occurrence of spontaneous " hyperinsulinism " as opposed to the " hypoinsulinism " of diabetes. The first verification of this hypothesis appeared in 1927 in a report by Wilder, Allan, Power and Robertson (26) of a case of intractable hypoglycemia. The patient, on exploration, showed carcinoma of the islet tissue of the pancreas with metastasis to the liver. Insulin was demonstrated in the hepatic metastases. Two years later Howland, Campbell, Maltby and Robinson (12) reported the first case of pancreatic islet adenoma which was diagnosed preoperatively, identified at operation and excised with favorable result.In the past few years the literature on hyperinsulinism has grown tremendously. A review by Whipple and Frantz (25) of all the published cases of hyperinsulinism and islet tumor has appeared very recently. According to their analysis of the 157 cases reported, 75 cases of hypoglycemia were ascribed to hyperinsulinism without verification at operation or autopsy. Of the 82 remaining cases in which the pancreas was examined, normal tissue was recorded in 13 instances, hypertrophy of the islands in 4 instances and chronic inflammatory change in 3, leaving 62 instances in which a tumor of the pancreatic islands was found. Analyzing further the 62 cases of tumor, exactly 50 per cent were incidental necropsy findings without recorded hypoglycemia. The group of 31 cases of tumor associated with hypoglycemia consists of 10 discovered at autopsy and 21 at operation. Among the last 21 cases, 4 were instances of carcinoma in which death occurred shortly after operation in 2 instances. In February 1934 generalized clonic convulsions were first noticed, accompanied by coma. Subsequently similar seizures recurred almost every night, usually between 2 and 4 a.m. According to the description given by his wife, the onset of the seizures was marked by a cessation of the snoring which occurred regularly during sleep and the opening of his eyes accompanied by staring and grimacing. Twitching movements first involved the lower limbs and then the upper. In the beginning the movements were slight and then more violent.Occasionally the tongue was bitten. Each series of con-249