Surgical aspects of hyperinsulinemic hypoglycemia.

Published on Sep 1, 1999in Endocrinology and Metabolism Clinics of North America3.813
· DOI :10.1016/S0889-8529(05)70087-6
Clive S. Grant109
Estimated H-index: 109
(Mayo Clinic)
Sources
Abstract
These cells lie together generally in considerablenumbers scattered diffusely in the parenchyma ofthe gland…. I must refrain from making anyhypothesis as to the nature and significance of our cells.PAUL LANGERHANS, 1869 25 Typically measuring only 1 to 2 cm in diameter and concealed within the normal pancreatic parenchyma, insulinomas frequently cause bizarre symptoms that may remain undiagnosed for years, even leading to serious mental deterioration. Simple excision completely and entirely resolves the problem. Paramount to establishing the diagnosis is the obvious, that is, thinking of it. Perhaps some of the difficulties and delays in establishing the diagnosis of insulinoma relate to its rarity. The incidence is estimated at only 4 per 1 million person-years. 34 Moreover, bizarre behavior and patients complaining of "spells" are not rare. Epidemiologic data on insulinoma derived from a pool of 224 patients who were evaluated and operated on over a 60-year period showed the median age to be 47 years (range, 8 to 82 years). Fifty-nine percent were female, and 7.6% had insulinoma as part of the multiple endocrine neoplasia type 1 syndrome (MEN-1); malignancy was encountered in 5.8%. 34 Experience with this disease must be accumulated over many years, and no institution worldwide has reported an average of more than nine cases per year. 9,13,16,24,27 The Mayo Clinic surgical experience with benign insulinomas consists of 145 patients operated on from July 1982 through October 1998, which serves as the database for this report and for the conclusions and recommendations made herein (Tables 1 and 2). This 16-year period marks the author's entire experience using intraoperative ultrasonography, a particularly notable advance in the surgical management of insulinoma.
📖 Papers frequently viewed together
1991
581 Citations
165 Citations
19913.36Surgery
7 Authors (Gerard M. Doherty, ..., C. Yeo)
161 Citations
References45
Newest
#2Neena Natt (UR: University of Rochester)H-Index: 1
#3Geoffrey B. Thompson (UR: University of Rochester)H-Index: 87
Last. Ricardo V. Lloyd (Mayo Clinic)H-Index: 94
view all 8 authors...
In adults, endogenous hyperinsulinemic hypoglycemia is almost invariably due to insulinoma. In these patients with insulinoma, neuroglycopenic episodes exclusively after meal ingestion and negative 72-h fasts are extraordinarily rare. We describe five adults with neuroglycopenic episodes from hyperinsulinemic hypoglycemia within 4 h of meal ingestion and negative 72-h fasts. Each had negative transabdominal ultrasonography, spiral computed tomographic scanning, and celiac axis angiography of the...
172 CitationsSource
#1Daniel C. Chung (Harvard University)H-Index: 76
#2Alison P. SmithH-Index: 7
Last. Andrew ArnoldH-Index: 42
view all 6 authors...
The molecular pathogenesis of pancreatic endocrine tumors is largely unknown. Such tumors are more likely to develop in individuals with the von Hippel-Lindau (VHL) syndrome. We sought to determine whether allelic loss of the recently identified VHL tumor suppressor gene on chromosome 3p25-26 occurs in the more common sporadic forms of these tumors. Allelic loss on chromosome 3p was identified in 33% of 43 patients with endocrine tumors of the pancreas. The smallest common region of allelic loss...
121 CitationsSource
#1John L. Doppman (NIH: National Institutes of Health)H-Index: 93
#2Chang RaH-Index: 2
Last. Phillip GordenH-Index: 94
view all 9 authors...
. Objective : To determine the sensitivity of calcium injected into pancreatic arteries in localizing insulin-secreting tumors to regions of the pancreas. . Design and Patients : To stimulate the release of insulin, 25 patients with surgically proven insulinomas (average diameter, 15 mm) had calcium gluconate (0.025 mEq Ca ++ /kg body weight) injected before surgery into the arteries supplying the pancreatic head (gastroduodenal and superior mesenteric arteries) and the body and tail (splenic ar...
231 CitationsSource
#1Florencia G. Que (Mayo Clinic)H-Index: 51
#2David M. Nagorney (Mayo Clinic)H-Index: 117
Last. Larry K. Kvols (Mayo Clinic)H-Index: 74
view all 5 authors...
Background Metastatic neuroendocrine malignancies frequently cause incapacitating endocrinopathies, and metastases predominant in the liver. Hepatic resection of metastases from such tumors is attractive because the natural history of neuroendocrine tumors is protracted, clinical severity of the endocrinopathy correlates with tumor volume, and local and intrahepatic growth characteristics often allow complete resection. Patients and methods To define the role of hepatic resection for metastatic ...
391 CitationsSource
#1Norman W. Thompson (UM: University of Michigan)H-Index: 78
#2Peter F. Czako (UM: University of Michigan)H-Index: 1
Last. James M. ScheimanH-Index: 66
view all 7 authors...
BACKGROUND: We have previously found selective venous sampling to be the most sensitive method to localize otherwise occult functioning endocrine tumors. However, recently we have used endoscopic ultrasonography (EUS) as the initial and in some cases the only localization study in the preoperative evaluation of proven insulinomas and of selected cases of gastrinoma. METHODS: All patients referred between April 1993 and April 1994 with a subsequently confirmed diagnosis of organic hyperinsulinism...
102 Citations
#1Diarmuid S. O'Riordain (Mayo Clinic)H-Index: 6
#2Timothy O'Brien (Mayo Clinic)H-Index: 90
Last. Clive S. Grant (Mayo Clinic)H-Index: 109
view all 4 authors...
Insulinoma in patients with multiple endocrine neoplasia (MEN) is a rare condition that because of its usual multicentricity presents difficulties not encountered in sporadic patients. In contrast to gastrinoma, which is the most common pancreatic neoplasm associated with MEN I, malignancy and duodenal tumors are much less common for patients with insulinomas, and excellent palliative medication is not available. Accordingly, there is a much greater reliance on surgical therapy for this group of...
116 CitationsSource
: It has been said that with the description of the Zollinger-Ellison syndrome in 1955, the clinical era of gastrointestinal endocrinology was inaugurated. Since that time, a virtual explosion of investigations, both basic and clinical, has occurred in which as many as 19 gastroenteropancreatic neuroendocrine cells have been identified and as many as 40 of their humoral products have been discovered. The pharmacologic and physiologic functions of some of these amines and peptides have been clear...
147 Citations
#1Geoffrey B. Thompson (Mayo Clinic)H-Index: 87
#3J. A. Van HeerdenH-Index: 47
Last. Edwin L. KaplanH-Index: 57
view all 9 authors...
Background. Between 1927 and 1992, 313 patients have undergone surgery for insulinoma(s) at our institution, 12% of which were reoperations. We retrospectively reviewed all cases (n=39) of reoperative surgery for persistent hyperinsulinism to identify chaging patterns in surgical approach, morbidity, and outcome and to evaluate the influence of preoperative and intraoperative localization studies. Methods. The diagnosis of endogenous hyperinsulinism has evolved from satisfying Whipple's triad to...
39 CitationsSource
#1Ihor J. Fedorak (Loyola University Medical Center)H-Index: 5
#2Tien C. Ko (LUC: Loyola University Chicago)H-Index: 8
Last. Richard A. Prinz (LUC: Loyola University Chicago)H-Index: 64
view all 5 authors...
Operative exploration with attempted curative resection should be attempted on virtually all patients with islet cell tumors of the pancreas who do not have metastatic disease evident on preoperative studies. Because of the small sire and variable location of many of these neoplasms, localization studies play an important role in ensuring appropriate and successful surgical therapy. A review of currently available preoperative and intraoperative aids for tumor localization is presented. A new te...
63 Citations
#1J. A. Van Heerden (Mayo Clinic)H-Index: 47
#2Clive S. GrantH-Index: 109
Last. Van HeerdenH-Index: 1
view all 4 authors...
BACKGROUND: An occult insulinoma refers to a biochemically proven tumor with an anatomic site that remains indeterminate before operation. The amount of radiologic localization for such patients is debatable. METHODS: Sixty-five patients with sporadic insulinomas were surgically treated at the Mayo Clinic between January 1980 and December 1990. True occult tumors were present in 31% of these patients (n = 20). Thirty-eight negative preoperative localization studies were performed, with 10 patien...
74 CitationsSource
Cited By56
Newest
#2Maryam GhadimiH-Index: 9
Last. Ihab R. KamelH-Index: 73
view all 4 authors...
Source
#1Dana PrídavkováH-Index: 3
#2Matej SamošH-Index: 7
Last. Marián MokáňH-Index: 10
view all 7 authors...
Insulinoma presenting with postprandial hypoglycemia and a low body mass index: A case report
Source
#1Maja Baretić (University Hospital Centre Zagreb)H-Index: 8
#2Dražen Perkov (University Hospital Centre Zagreb)H-Index: 1
Last. Mato Škegro (University of Zagreb)H-Index: 1
view all 5 authors...
Dear Editor,We read the manuscript “Surgery in overweight patients with insulinoma: effects on weight loss” [1] with great interest and decided to share our experiences in treating patients with in...
1 CitationsSource
#1Ko Harada (Okayama University)H-Index: 3
#2Yoshihisa Hanayama (Okayama University)H-Index: 6
Last. Fumio Otsuka (Okayama University)H-Index: 35
view all 7 authors...
: Insulinoma is a rare, usually benign, pancreatic neuroendocrine tumor. The clinical features of an insulinoma are fasting hypoglycemia with neuroglycopenic symptoms including confusion and unusual behavior, while hypertension is usually not associated with the disease. We herein report a patient with insulinoma who manifested paroxysmal hypertension and neuroglycopenic symptoms. The possible etiology of hypertension induced by an insulinoma is catecholamine release in response to hypoglycemia,...
Source
Resumo Os insulinomas constituem o tumor neuroendocrino pancreatico funcionante mais frequente. O objetivo deste estudo foi avaliar retrospetivamente as caracteristicas dos insulinomas diagnosticados no Centro Hospitalar do Porto (CHP) em 10 anos. A analise dos doentes com insulinoma seguidos na consulta de Endocrinologia do CHP‐HSA de 2002‐2012 levou a identificacao de 14 casos. A maioria dos insulinomas eram tumores unicos. A triade de Whipple foi a manifestacao inicial destes tumores e o test...
Source
#1Stephen DavisH-Index: 5
#1Stephen N. DavisH-Index: 57
Last. Lisa M. YounkH-Index: 11
view all 3 authors...
1 CitationsSource
#1Hoda kadkhodazadeh (Shahid Beheshti University of Medical Sciences and Health Services)
#2Muhanna KazempourH-Index: 2
Last. Babak Salevatipour (Shahid Beheshti University of Medical Sciences and Health Services)H-Index: 2
view all 3 authors...
Introduction: Insulinoma is one of the most common neuro-endocrine tumors of the pancreas. Some cases with insulinoma present neuropsychiatric symptoms and are often misdiagnosed as psychosis thus patients may remain symptomatic from one week to as long as several decades before diagnosis. Case Presentation: A 68-year-old male patient, who presented episodic seizures and a normal Electroencephalography (EEG) recording for the past fourteen years, had referred for evaluation of hypoglycemia. His ...
Source
Insulinoma is rare a tumor of the islet cell of the pancreas that produces excessive amounts of insulin, inappropriately to plasma glucose levels. The average age of onset 40-50 years. The typical symptoms that patients complain about are related to the development of hypoglycemia. Patients with insulinoma usually develop neuroglycopenic symptoms (confusion, headache, visual difficulties, irrational behavior and extremely, coma) particularly with exercise or fasting. Severe hypoglycemia may resu...
1 CitationsSource
Insulinoma is rare a tumor of the islet cell of the pancreas that produces excessive amounts of insulin, inappropriately to plasma glucose levels. The average age of onset 40-50 years .The typical symptoms that patients complain about are related to the development of hypoglycemia. Patients with insulinoma usually develop neuroglycopenic symptoms (confusion, headache, visual difficulties, irrational behavior and extremely, coma) particularly with exercise or fasting. Severe hypoglycemia may resu...
Source
#1Shema Hameed (Imperial College London)
#2Mark Wills (Salisbury NHS Foundation Trust)H-Index: 1
Last. Andrea Rockall (Imperial College London)H-Index: 52
view all 3 authors...
Neuroendocrine tumours (NETs) may arise from the gastrointestinal tract and pancreas (collectively known as gastroenteropancreatic neuroendocrine tumours, GEP-NETs) and from neuroendocrine cells scattered in other tissues. Non-functioning tumours, in which there is no recognisable clinical syndrome, often present late with symptoms due to mass effect, although small non-functioning lesions may be detected when screening family groups with genetic disorders associated with NETs. Functioning tumou...
Source