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Insulinoma

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Opinion statement

Insulinomas are the most common islet cell tumors and are located almost exclusively in the pancreas. Most of these tumors are sporadic, but they may also be associated with the multiple endocrine neoplasia type I syndrome. More than 90% of insulinomas are benign. Preoperative radiographic localization may prove difficult. Intraoperative palpation and ultrasound remain the gold standard for detection and appropriately planned resection. Although many options are available to treat the patient with malignant and metastatic disease, the mainstay of treatment remains surgery. Laparoscop ultrasound and enucleation/resection may be increasingly used in the management of patients with insulinoma.

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References and Recommended Reading

  1. Banting FG, Best CH: Internal secretion of the pancreas. J Lab Med 1922, 7:251.

    CAS  Google Scholar 

  2. Wilder RM, Allan FN, Power MH, et al.: Carcinoma of the islands of the pancreas: hyperinsulinism and hypoglycemia. JAMA 1927, 89:348–355.

    CAS  Google Scholar 

  3. Howland G, Campbell WR, Maltby EJ, et al.: Dysinsulinism: convulsions and coma due to islet cell tumor of the pancreas with operation and cure. JAMA 1929, 93:674–679.

    Google Scholar 

  4. Service FJ, McMahon MM, O’Brien PC, Ballard DJ: Functioning insulinoma: incidence, recurrence and longterm survival of patients: a 60-year study. Mayo Clin Proc 1991, 66:711–719. A long-term institutional experience from a major referral center.

    PubMed  CAS  Google Scholar 

  5. Whipple AO, Frantz VK: Adenoma of the islet cell with hyperinsulinism. Ann Surg 1935, 101:1299–1304.

    Article  PubMed  CAS  Google Scholar 

  6. Service FJ: Hypoglycemic disorders. N Engl J Med 1995, 332:1144–1152. An excellent review on the diagnostic approach to the patient who is hypoglycemic.

    Article  PubMed  CAS  Google Scholar 

  7. Boukhman MP, Karam JM, Shaver J, et al.: Localization of insulinomas. Arch Surg 1999, 134:818–823. A comparison of the insulinoma localization technique.

    Article  PubMed  CAS  Google Scholar 

  8. Thompson GB: Insulinoma. In Endocrine Surgery. Edited by Prinz RA, Staren ED. Georgetown: Landes Bioscience; 2000:222–228.

    Google Scholar 

  9. Hiramoto JS, Feldstein VA, LaBerge JM, Norton JA: Intraoperative ultrasound and preoperative localization detects all occult insulinomas. Arch Surg 2001, 136:1020–1025.

    Article  PubMed  CAS  Google Scholar 

  10. Correnti S, Liverani A, Antonini G, et al.: Intraoperative ultrasonography for pancreatic insulinomas. Hepatogastroenterology 1996, 43:207–211.

    PubMed  CAS  Google Scholar 

  11. Lo CY, Lam KY, Kung AW, et al.: Pancreatic insulinomas: a 15-year experience. Arch Surg 1997, 132:926–930.

    PubMed  CAS  Google Scholar 

  12. Wayne JD, Tanaka R, Kaplan EL: Insulinomas. In Endocrine Surgery. Edited by Clark OH, Duh QY. Philadelphia: WB Saunders Company; 1997:577–591.

    Google Scholar 

  13. Saer AJ: Management of hyperinsulinemia with diazoxide in an elderly hemodialysis patient. Nephron 2001, 89:337–339.

    Article  Google Scholar 

  14. Brenthens R, Saltz L: Islet cell tumors of the pancreas: the medical oncologist’s perspective. Surg Clin North Am 2001, 81:527–542. A discussion of the multidisciplinary approach to the patient with insulinoma.

    Article  Google Scholar 

  15. Boden G: Glucagonomas and insulinomas. Gastroenterol Clin North Am 1989, 18:831–845.

    PubMed  CAS  Google Scholar 

  16. Gill GV, Rauf IA, MacFarlane IA: Diazoxide treatment for insulinomas: a national UK survey. Postgrad Med J 1997, 73:640–641.

    Article  PubMed  CAS  Google Scholar 

  17. Arnold R, Frank M, Kajdan U: Management of gastroenteropancreatic endocrine tumors: the place of somatostatin analogues. Digestion 1994, 55(Suppl 3):107–113.

    PubMed  Google Scholar 

  18. Saltz L, Trochanowsky B, Buckley M, et al.: Octreotide as an antineoplastic agent in the treatment of functional and non-functional neuro-endocrine tumors. Cancer 1993, 72:244–248.

    Article  PubMed  CAS  Google Scholar 

  19. Moertel CG, Hanley JA, Johnson LA: Streptozocin alone compared with streptozocin plus fluorouracil in the treatment of advanced islet-cell carcinoma. N Engl J Med 1980, 303:1189–1194.

    Article  PubMed  CAS  Google Scholar 

  20. Kvols LK, Buck M: Chemotherapy of endocrine malignancies: a review. Semin Oncol 1987, 14:343–353.

    PubMed  CAS  Google Scholar 

  21. Moertel CG, Lefkopoulo M, Lipsitz S, et al.: Streptozocin-doxorubicin, streptozocin-fluorouracil, or chlorozotocin in the treatment of advanced islet-cell carcinoma. N Engl J Med 1992, 326:519–523. An impotant series showing a survival benefit of chemotherapy in patients with advanced disease.

    Article  PubMed  CAS  Google Scholar 

  22. Rougier P, Mitry E: Chemotherapy in the treatment of neuroendocrine malignant tumors. Digestion 2000, 62(Suppl 1):73–78.

    Article  PubMed  CAS  Google Scholar 

  23. Sridhar KS, Holland JF, Brown JC, et al.: Doxorubicin plus cisplatin in the treatment of apudomas. Cancer 1985, 55:2634–2637.

    Article  PubMed  CAS  Google Scholar 

  24. Marsh RW, Killeen RB Jr: Efficacy of the combination of carboplatin and cyclophosphamide in the treatment of metastatic insulinoma. Cancer Invest 1992, 10:523–524.

    PubMed  CAS  Google Scholar 

  25. Ollivier S, Fonck M, Becouarn Y, Brunet R: Dacarbazine, fluorouracil, and leucovorin in patients with advanced neuroendocrine tumors: a phase II trial. Am J Clin Oncol 1998, 21:237–240.

    Article  PubMed  CAS  Google Scholar 

  26. Moertel CG, Kvols LK, O’Connell MJ, Rubin J: Treatment of neuroendocrine carcinomas with combined etoposide and cisplatin. Cancer 1991, 68:227–232.

    Article  PubMed  CAS  Google Scholar 

  27. Hesdorffer CS, Stoopler M, Javitch J: Aggressive insulinoma with bone metastases. Am J Clin Oncol 1989, 12:498–501.

    Article  PubMed  CAS  Google Scholar 

  28. Ulbrecht JS, Schmeltz R, Aarons JH, Greene DA: Insulinoma in a 94-year-old woman: long-term therapy with verapamil. Diabetes Care 1986, 9:186–188.

    Article  PubMed  CAS  Google Scholar 

  29. Hofeldt FD, Dippe SE, Levin SR, et al.: Effects of diphenylhydantoin upon glucose-induced insulin secretion in three patients with insulinoma. Diabetes 1973, 23:192–198.

    Google Scholar 

  30. Blum I, Doron M, Laron Z, et al.: Prevention of hypoglycemic attacks by propranolol in a patient suffering from insulinoma. Diabetes 1975, 24:535–537.

    Article  PubMed  CAS  Google Scholar 

  31. Markowitz JC: The hepatic artery. Surg Gynecol Obstet 1953, 95:644–646.

    Google Scholar 

  32. Ahlman J, Wangberg B, Jansson S, et al.: Interventional treatment of gastrointestinal neuroendocrine tumours. Digestion 2000, 62(Suppl 1):59–68.

    Article  PubMed  Google Scholar 

  33. Marlink RG, Lokich JJ, Robins JR, Clouse ME: Hepatic arterial embolization for metastatic hormone-secreting tumors: technique, effectiveness, and complications. Cancer 1990, 65:2227–2232.

    Article  PubMed  CAS  Google Scholar 

  34. Moertel CG, Johnson CM, McKusick MA, et al.: The management of patients with advanced carcinoid tumors and islet cell carcinomas. Ann Intern Med 1994, 120:302–309.

    PubMed  CAS  Google Scholar 

  35. Berwaerts J, Verhelst J, Hubens H, et al.: Role of hepatic arterial embolisation in the treatment of metastatic insulinoma: Report of two cases and review of the literature. Acta Clin Belg 1997, 52:263–274.

    PubMed  CAS  Google Scholar 

  36. Azimuddin K, Chamberlain RS: The surgical management of pancreatic neuroendocrine tumors. Surg Clin North Am 2001, 81:511–525. A review of the surgical approach to neuroendocrine tumors of the pancreas.

    Article  PubMed  CAS  Google Scholar 

  37. Bliss RD, Carter PB, Lennard TW: Insulinoma: a review of current management. Surg Oncol 1997, 6:49–59. A clear overview of diagnosis and management of insulinoma.

    Article  PubMed  CAS  Google Scholar 

  38. Sperti C, Pasquali C, Ferronato A, Pedrazzoli S: Median pancreatectomy for tumors of the neck and body of the pancreas. J Am Coll Surg 2000, 190:711–716.

    Article  PubMed  CAS  Google Scholar 

  39. Evans DB, Lee JE, Pisters PWT, et al.: Periampullary cancer. In Current Surgical Therapy. Edited by Cameron JL. St Louis: Mosby; 2001:558–567.

    Google Scholar 

  40. Nakagawa M, Sasakuma F, Kishi Y, Ishikawa O: A successful monitoring for intraoperative calcium stimulation test in complete resection of pancreatic insulinoma. Anesth Analg 2001, 93:239–240.

    Article  PubMed  CAS  Google Scholar 

  41. Lo CY, van Heerden JA, Thompson GB, et al.: Islet cell carcinoma of the pancreas. World J Surg 1996, 20:878–884.

    Article  PubMed  CAS  Google Scholar 

  42. Machado MC, da Cunha JE, Jukemura J, et al.: Insulinoma: diagnostic strategies and surgical treatment. A 22-year experience. Hepatogastroenterology 2001, 48:854–858.

    PubMed  CAS  Google Scholar 

  43. Modlin IM, Lewis JJ, Ahlman H, et al.: Management of unresectable malignant endocrine tumors of the pancreas. Surg Gynecol Obstet 1993, 176:507–518.

    PubMed  CAS  Google Scholar 

  44. Gagner M, Pomp A, Herrera MF: Early experience with laparoscopic resection of islet cell tumors. Surgery 1996, 120:1051–1054.

    Article  PubMed  CAS  Google Scholar 

  45. Sussman LA, Christie R, Whittle DE: Laparoscopic excision of distal pancreas including insulinoma. Aust N Z J Surg 1996, 66:414–416.

    PubMed  CAS  Google Scholar 

  46. Berends FJ, Cuesta MA, Kazemier G, et al.: Laparoscopic detection and resection of insulinomas. Surgery 2000, 128:386–391.

    Article  PubMed  CAS  Google Scholar 

  47. van Nieuwenhove Y, Delvaux G: Laparoscopic management of neuroendocrine tumours of the pancreas. Acta Chir Belg 1999, 99:249–252.

    PubMed  Google Scholar 

  48. Tihanyi TF, Morvay K, Nehez L, et al.: Laparoscopic distal resection of the pancreas with the preservation of the spleen. Acta Chir Hung 1997, 36:359–361.

    PubMed  CAS  Google Scholar 

  49. Iihara M, Kanbe M, Okamoto T, et al.: Laparoscopic ultrasonography for resection of insulinomas. Surgery 2001, 130:1086–1091.

    Article  PubMed  CAS  Google Scholar 

  50. Anthuber M, Jauch KW, Briegel J, et al.: Results of liver transplantation for gastroenteropancreatic tumor metastases. World J Surg 1996, 20:73–76.

    Article  PubMed  CAS  Google Scholar 

  51. Moscetti L, Saltarelli R, Giuliani R, et al.: Intra-arterial chemotherapy and hormone therapy in malignant insulinoma: case report and review of the literature. Tumori 2000, 86:475–479.

    PubMed  CAS  Google Scholar 

  52. Smith CM, Liu J, Chen T, et al.: OctreoTher: ongoing early clinical development of a somatostatin-receptortargeted radionuclide antineoplastic therapy. Digestion 2000, 62(Suppl 1):69–72.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgical Oncology, Section of Endocrine Surgery, Princess Margaret Hospital, Mount Sinai Hospital, University of Toronto, 610 University Avenue, Suite 3-130, M5G 2M9, Toronto, Ontario, Canada

    Alan P. B. Dackiw MD, PhD

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  1. Andrew R. Burns MD
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  2. Alan P. B. Dackiw MD, PhD
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Burns, A.R., Dackiw, A.P.B. Insulinoma. Curr. Treat. Options in Oncol. 4, 309–317 (2003). https://doi.org/10.1007/s11864-003-0006-y

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  • DOI: https://doi.org/10.1007/s11864-003-0006-y

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