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)
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.
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