Surgery for benign insulinoma: An international review

Rothmund, M.; Angelini, Lucio; Brunt, L. Michael; Farndon, John; Geelhoed, Glenn W.; Grama, D; Herfarth, Christian; Kaplan, Edwin L.; Largiadèr, F; Morino, F; Peiper, H. J.; Proye, C; Röher, H. D.; Rückert, K; Kümmerle, F; Thompson, Norman W.; Heerden, Jon A. van

doi:10.1007/bf01658536

Cited by 145 publications

(110 citation statements)

References 13 publications

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“…The treatment of choice for adenomatous hyperplasia of pancreatic cells, micro or macro adenoma, is surgical removal (4). On the contrary, diffuse hyperplasia, arisen by islet cell dysregulation of insulin production, can only be cured by near-total (95%) pancreatectomy as the initial procedure of choice when medical therapy has failed (5).…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive surgical interventions in the treatment of primary persistent hyperinsulinemic hypoglycemia of infancy

Soheilipour

Jamshidi

Ahmadi

et al. 2015

Arch. Endocrinol. Metab.

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SUMMARYHyperinsulinemia, diagnosed by laboratory tests, should be diagnosed and treated as soon as possible to prevent fatal complications such as neurological damage. Patients who are resistant to medical therapy should be treated surgically. Minimally invasive surgery, a newly developed approach, is a good choice among surgical procedures to avoid unnecessary extensive pancreatectomy. Here, a 12-year-old boy is presented with diagnosis of hyperinsulinemic hypoglycemia who had recurrent attacks of hypoglycemia and seizures from infancy. Because of his unresponsiveness to medical therapy and his family's preference, he underwent laparoscopic pancreatectomy to reduce morbidity and hospital stay. Two years postsurgical follow-up revealed a normo-glycemic state. Arch Endocrinol Metab. 2015;59(5):466-9

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Section: Introductionmentioning

confidence: 99%

Minimally invasive surgical interventions in the treatment of primary persistent hyperinsulinemic hypoglycemia of infancy

Soheilipour

Jamshidi

Ahmadi

et al. 2015

Arch. Endocrinol. Metab.

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“…Once a biochemical diagnosis of an insulinoma has been made, it has to be borne in mind that 40% of insulinomas are less than 1 cm in diameter, and may therefore escape detection during preoperative investigations (echography, computed tomography (CT) scan, arteriography) (15). As there may also be uncertainty about the number and localization of the tumors, we report our experience using euglycemic control (an adaptation of the euglycemic clamp technique, without infusion of insulin), for the intraoperative management of patients with insulinoma(s),…”

Section: Introductionmentioning

confidence: 99%

Experience with the Biostator for diagnosis and assisted surgery of 21 insulinomas

Gin

Catargi²,

Rigalleau³

et al. 1998

European Journal of Endocrinology

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Surgical removal is the treatment of choice for insulinomas. Definitive biochemical diagnosis of organic hyperinsulinism has to be established before surgery. These tumors are sometimes undetected by preoperative imaging investigations and, in addition, surgical management may also be complicated by the absence of palpable tumors or the presence of multiple tumors. We report the value of the euglycemic clamp technique for diagnosis and surgical treatment in 21 patients with confirmed insulinomas. Data were compared with 12 controls, and nine patients were retested after surgery. During the euglycemic hyperinsulinic clamp, the mean C-peptide value was 3.6 Ϯ 2.2 ng/ml and it remained high (3.8 Ϯ 2.5 ng/ml), despite exogenous hyperinsulinemia (1762.7 Ϯ 233.2 mU/ml for the highest plateau). In contrast, the C-peptide concentration declined in 12 control patients (0.3 Ϯ 0.1 ng/ml, P < 0.001) and after successful surgery in nine retested patients (0.3 Ϯ 0.2 ng/ml, P < 0.01). During continuous glucose monitoring, successful removal of the insulin-secreting tumor was accompanied by an increase in plasma glucose concentrations and a loss of requirement for endogenous glucose within 36 min (range 28-43 min). The continuing requirement for glucose after the ablation of the tumor revealed the existence of additional and initially undetected tumors in four patients, among whom two had the multiple endocrine neoplasia type I (MEN I) syndrome.We conclude that the euglycemic hyperinsulinic clamp is a reliable and convenient diagnostic test for insulinoma, as it is both safe (no hypoglycemia) and relatively brief (3 × 90 min). Glucose monitoring and glucose clamping provide a reliable indicator of complete removal of insulinhypersecreting tissue, especially in patients with occult or multiple tumors.

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“…For instance, a cure rate of more than 90% of the patients has been reported for sporadic insulinoma. 20 Debulking, cytoreductive surgery or complete liver metastatectomy in selected patients with liver-only diseases in metastatic GEP-NETs, confer both improved symptoms control and long-term survivorship. 21 It also has an added benefit of rendering medical therapy more effectively in controlling the residual tumour.…”

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confidence: 99%

Surgery in the Era of Molecular Medicine: Review of Gastroenteropanreatic Neuroendocrine Tumours

Liau¹

2017

Surg Res Open J

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Surgery for benign insulinoma: An international review

Cited by 145 publications

References 13 publications

Minimally invasive surgical interventions in the treatment of primary persistent hyperinsulinemic hypoglycemia of infancy

Minimally invasive surgical interventions in the treatment of primary persistent hyperinsulinemic hypoglycemia of infancy

Experience with the Biostator for diagnosis and assisted surgery of 21 insulinomas

Surgery in the Era of Molecular Medicine: Review of Gastroenteropanreatic Neuroendocrine Tumours

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