The management of insulin tumours of the pancreas

Abstract

Summary A series of 26 patients diagnosed as having an insulin-secreting, islet-cell tumour of the pancreas is described. Three patients were treated medically, but in the remaining 23 the tumour was found at operation; 1 patient had a carcinoma with hepatic metastases, but in the other 22 the tumour was apparently benign and the subsequent course of these patients has confirmed this conclusion. The tumour was found at the initial operation in 19 of the 22 patients with a benign tumour treated surgically. Of the other 3, the tumour was removed at a second operation in 2 and at a third operation in 1. Two of the 22 patients died following the operation. Diazoxide was administered to 21 patients, before and/or after operation. It was given preoperatively to 17 patients, in all of whom it prevented the development of hypoglycaemic symptoms, but in 2 it caused serious fluid retention and had to be discontinued. Seven patients have been successfully treated with long term diazoxide, either as an alternative to surgery or following an unsuccessful operation, 1 of these being the patient with an islet-cell carcinoma. In these patients diazoxide has been given for up to 12 years without apparent side effects. Selective coeliac angiography was performed in 13 patients. In no patient did it provide critical information that significantly influenced the treatment of the patient. Percutaneous, transhepatic portal venous catheterization was performed in 4 patients and indicated the site of the tumour in 3, 2 of whom had had 1 previous operation and 1 had had 2 previous operations, at none of which was a tumour found: in all 3 patients the tumour was removed at a subsequent operation. The application of these findings to the management of patients with an insulinoma is discussed and a scheme of management is proposed.