Pancreatic insulinomas – clinical, diagnostical and therapeutical aspects

Abstract

Introduction. Insulinomas are neuroendocrine tumors with low incidence (1-4 persons per million of general population), and represents 1-2% of total pancreatic neoplasm. Material and methods. The study presents the results of surgical treatment applied to 9 patients diagnosed with pancreatic endocrine tumor (PET) - between 1993 - 2016 in the Departament of surgery Nr.2 The diagnostic management has included a clinical and laboratory examination, (glycemic profile, the glycemic index during hypoglycemic and convulsive crises, glycemic levels after the administration of glucose solutions of 40%, assessment of the level of serum insulin, echography, CT, MRI. Results. The symptomatology is dominated by neuropsychiatric symptoms – 8 (88,8%) cases, adrenergic symptoms – 6 (66,6%) cases, digestive - 5 (55,56%) cases and Cushingoid syndrome 1 (11,1%) case. After evaluating the glycemic profile, the glycemic level of hypoglycemic and convulsions crisis was within 2-3,0mmol; the glycemic level after the administration of glucose solutions of 40% was 3,8-5,5mmol, the level of serum insulin was increased 32,45U/mL, level of C-peptide - 4,6 ng/ml. The elective surgeries included: tumor enucleation in 5 (55,6%) cases, corporeal-caudal pancreatectomy with spleen preservation in 3 (33,33%) cases, corporeal- caudal pancreatectomy with splenectomy in 1 (11,1%) case. Mortality and morbidity perioperative were 0. Conclusion. Delays in diagnosis are caused by a non-specific symptomatology (cardiac, neurological, psychiatric symptoms), the pancreatic enucleoresection being the treatement of election.