Multiple Insulinomas Research Articles

Challenges in Managing Insulinomas and Hyperparathyroidism in MEN1: A Clinical Case Study

Pancreatic insulinoma is an uncommon neuroendocrine tumor with an incidence of approximately 1 per million people annually. While the majority of insulinomas are sporadic, a minority are associated with Multiple Endocrine Neoplasia type 1 (MEN1), a rare genetic disorder transmitted in an autosomal dominant pattern. MEN1 is characterized by the presence of hyperplastic or adenomatous parathyroid glands, pancreatic islet cell tumors, and pituitary tumors. The disorder can also involve lesions in the duodenum, adrenal glands, thymus, and bronchi. We report a case of MEN1 presenting with multiple insulinomas in a 37-year-old male, who exhibited symptoms of intermittent hypoglycemia over a decade. Diagnostic workup included biochemical assays , and imaging studies that revealed elevated insulin and C-peptide levels and hypervascular pancreatic lesions, , and pathological findings consistent with MEN1. Surgical intervention involved the enucleation of insulinomas and distal pancreatectomy, followed by removal of parathyroid adenomas. The postoperative evolution was marked by the resolution of hypoglycemic episodes and the persistence of primary hyperparathyroidism. This case underscores the complexity of diagnosing and managing insulinomas within the context of MEN1. It highlights the importance of a multidisciplinary approach to treatment and the need for ongoing surveillance to address both endocrine manifestations and psychological impacts. The findings advocate for comprehensive management strategies and support systems to improve patient outcomes and quality of life.

6538 Find me if you can! A Case of a "Well Placed Solitary Insulinoma" in "The Center" of an SACST

Abstract Disclosure: R. Kennedy: None. D.A. D'Alessio: None. A.V. Vella: None. Introduction: Selective arterial calcium stimulation testing (SACST) can be utilized in patients to localize solitary insulinomas when imaging is non diagnostic. While a heterogenous stimulation pattern suggests NIPHS, or multiple insulinomas this case uniquely demonstrates such a pattern with a solitary insulinoma. Clinical Case: The patient is a 48 year old female who presented to the emergency department (ED) for bizarre behavior which resolved with a sweetened drink. Serum glucose was 62 mg/dL, she was treated with IV dextrose and was discharged from the ED. She was referred to outpatient endocrinology for further evaluation where continuous glucose monitoring confirmed predominantly fasting hypoglycemia. Adrenal insufficiency was excluded. She was admitted for a 72 hour inpatient fast where the patient achieved hypoglycemia within 24 hours, with glucose 46 mg/dL (associated with neuroglycopenic symptoms), beta hydroxybutyrate < 0.18 mmol/L, insulin 3.9 mcIU/mL, proinsulin 157pmol/L, c-peptide 1.4 ng/mL and a glucose rise greater than 25mg/dL after glucagon administration. Sulfonylurea screen and insulin antibodies were negative; IGF1 within normal limits. These labs were consistent with hyperinsulinemic hypoglycemia. An MRI pancreas however did not reveal an insulinoma. The patient therefore underwent a SACST, demonstrating a 10 fold response in the territory of the gastroduodenal artery and splenic artery, as well as a 3 fold response in the superior mesenteric artery. This heterogenous pattern in addition to the marked response in each arterial territory raised the possibility of multiple insulinomas. However as there were no tumors present on imaging, medical management was initiated with close follow up. She was trialed with months of somatostatin analogs and diazoxide with minimal improvement in the frequency and severity of her hypoglycemia. About a year after her initial diagnosis, repeat abdominal imaging (CT and MRI) revealed an 8 mm arterial hyper-enhancing lesion in the body of the pancreas concerning for neuroendocrine tumor. Repeat SACST was performed, this time showing a greater than 10 fold response in all three arterial territories. Angiography showed a tumor blush that was visible when each of the three major arteries were injected sequentially. She underwent laparoscopic pancreatic enucleation. The lesion was located on the body of the pancreas, with histology confirming an insulinoma. The patient responded promptly post operatively; her symptoms resolved without further need of medical management. Conclusion: Our case shows that the interpretation of an SACST should take into account the arterial anatomy before ascribing a non-focal response to multiple territories of insulin hypersecretion. Presentation: 6/1/2024

Patient with multifocal pancreatic insulinoma: a rare presentation of functional pancreatic neuroendocrine neoplasm

Insulinoma is a type of neuroendocrine tumour with an incidence of 1—4 cases per million. Multiple insulinomas constitute less than 10% of all insulinomas. Surgery is the treatment of choice for insulinoma. The operation can be done with an open or laparoscopic approach, with cure rates ranging from 77% to 100%. Pancreatic resection is recommended for tumours larger than 2 cm in size, while enucleation is advised for lesions smaller than 2cm if the tumour is at least 2—3 mm away from the main pancreatic duct to prevent the formation of a fistula. For better intraoperative localization of lesions, bimanual palpation together with intraoperative ultrasonography (IOUS) is advised. Palpation alone has 70% sensitivity, but together with IOUS, it reaches 85—95%
 A young female patient in her late 20s with non‑specific complaints and a medical history of epilepsy dating back to the age of 17 underwent a physical examination. Blood test results indicated severe hypoglycemia, and magnetic resonance imaging (MRI) revealed an 11‑mm neoplasia in the body of the pancreas. A 72‑hour fasting test confirmed the diagnosis of insulinoma, and the patient underwent laparoscopic surgery. IOUS was done for the precise localization of the lesion, and another tumour in the pancreatic tail was found. A spleen‑preserving laparoscopic distal pancreatectomy was performed. Histologic reports confirmed multifocal Grade 1 insulinoma. The postoperative course was uneventful. After 4 months of follow‑up, computed tomography (CT) was done, and there were no signs of recurrence of insulinoma, pancreatic pseudocysts, or other signs of postoperative complications. Since the operation, the patient has not had any episodes of hypoglycemia or seizures.
 The wide spectrum of symptoms, which are not specific to insulinomas, in particular seizures, can make it difficult to establish a correct diagnosis and can be mistaken for other psychiatric or neurologic disorders. This case clearly shows the advantages of IOUS‑guided surgery in achieving better visualization and outcomes. After enucleation of the smaller lesion without the use of IOUS, other insulinomas would be missed and left in place because they were located deeply in the parenchyma. Simple visualization and palpation would not be enough.

FRI668 Insulinoma As A Cause Of New Onset Hypoglycemic Episodes

Abstract Disclosure: S. Zahra: None. M.A. Abbas: None. R. Subramani: None. F. Manas: None. S. Yavuz: None. 37 years old female with a past medical history of hypothyroidism presented with complaints of shakiness, lightheadedness, and palpitations, relieved by eating. The physical examination was unremarkable. Fasting blood work showed low glucose of 41 mg/dl (70-99 mg/dl), normal insulin levels of 8.4 UIU/ ml (normal:1.9-23 UIU/ml), elevated proinsulin 21.1 pmol/ L (normal:<8.0 pmol/L), normal C Peptide 2.5 ng/ ml (normal:1.1-4.4 ng/ml), and negative for insulin antibody. Serum ACTH and cortisol levels were normal. Blood testing for hypoglycemia-inducing medications was negative. CT and MRI abdomen pelvis contrast was normal. She was prescribed to wear Dexcom to monitor her blood glucose round the clock. She continued to have low blood glucose, sometimes without symptoms and was rescued by the alarm. She underwent endoscopic ultrasound and was found to have a 10mm x 9mm ill-defined rounded pancreatic head mass with diffuse echogenicity of the pancreas. Biopsy of the mass revealed clusters of epithelial cells with neuroendocrine differentiation, compatible with insulinoma. She underwent surgical resection of the mass. She was also referred to genetic testing due to the association of pancreatic tumors with MEN syndrome. The diagnosis of Insulinomas is clinical as well as biochemical with presenting symptoms of Whipple’s Triad along with the presence of the following lab findings: hypoglycemia with plasma glucose of less than 50mg /dl, insulin greater than 5 UIU/L, C-Peptide greater than 0.2 nmol/L (0.6 ng/mL), Insulin/C-Peptide ratio of greater than 1.0, Proinsulin greater than 20pmol/L, and the absence of sulfonylurea metabolites in plasma or urine. Insulinoma is the most common pancreatic neuroendocrine and functional endocrine tumor of the beta cells of the pancreas with a prevalence of 1-4 people per million with equal gender distribution. They are mainly seen in the fifth decade of life but can occur at any age. They can occur sporadically or can be associated with MEN 1. Insulinomas are mostly benign, about 5-10% can be malignant. When to do medical vs surgical management? For benign insulinomas, surgical resection is preferred. For locally invasive and malignant tumors, aggressive surgical resection is performed, unless surgery is contraindicated for any other reason or patient refuses it. Medical treatment is reserved for the patients with diffuse Beta cell disease, multiple insulinoma and unresected malignant insulinoma. In the presence of unresectable metastatic disease; radiofrequency ablation, selective embolization, intraarterial chemotherapy, alone or in combination has been shown to be effective in controlling hypoglycemic episodes and improving quality of life. Octreotide, via inhibiting insulin secretion, normalizes the blood glucose levels. For better detection of hypoglycemia and adequate response to medical therapy, continuous glucose monitoring is helpful. Presentation: Friday, June 16, 2023

Abstract #1323564: Pancreatic Insulinoma: A Case Report From Kuwait

An insulinoma is a neuroendocrine tumor that is mainly derived from pancreatic islets cells and that secretes insulin. Approximately 90% of insulinomas are benign and 10% are malignant, and 10% of patients have multiple insulinomas. They can occur in association with MEN1. Mostly they occur in the fifth decade of life. Insulinomas are rare tumors, with an annual incidence of 4 cases per million patients. Hypoglycemia is the most common manifestation, with distinct episodes of neuroglycopenic and sympathetic symptoms.

Analysis of 55 patients with multiple endocrine neoplasia type 1-associated insulinoma from a single center in China

ObjectiveTo investigate the clinical characteristics of patients with multiple endocrine neoplasia type 1 (MEN1)-related insulinoma and their relationship with specific biochemical changes and to summarize the features of treatment options for the Chinese population with this disease and the impact on long-term prognosis.Methods“MEN1” and “insulinoma” were used when searching the Peking Union Medical College Hospital (PUMCH) medical record retrieval system to obtain clinical information about patients. We identified patients diagnosed with MEN1-associated insulinoma based on endocrinological, radiological, and pathological examinations, and subsequently analyzed their clinical data.ResultsA total of 55 patients with MEN1-associated insulinoma were included, including 29 (52.7%) men and 26 (47.3%) women. The parathyroid gland was the most commonly affected (78.2%), followed by the pituitary gland (69.1%) and adrenal gland (16.4%). Insulinoma was the first manifestation of MEN1 in at least 23.6% (13/55) of patients. Nineteen (34.5%) patients presented with initial symptoms of hypoglycemia before the age of 22 years. Among the 24 Patients with high serum calcium (Ca) had significantly lower serum insulin levels than those with normal serum Ca levels (p < 0.001) during hypoglycemic episodes. However, serum C-peptide level at 0.5 h and serum insulin level at 1 h was higher in patients with hypercalcemia than in patients with normal serum Ca levels in the oral glucose tolerance test (OGTT), although the differences were not statistically significant. Multifocal pancreatic neuroendocrine tumors (pNETs) were present in 38 (69.1%) patients; most of them (55.6%, 20/36) underwent multiple enucleations, and 45% (9/20) had a postoperative recurrence. Five patients (10%) who underwent distal pancreatectomy developed pancreatic insufficiency after an average of seven years. patients who underwent genetic testing, 23 (95.8%) were positive for MEN1 mutation, with mutations most commonly found in exons 2 (21.7%) and 3 (13%).ConclusionsIn our study, the rates of postoperative recurrence and long-term complications in patients with MEN1 with multifocal pNETs were significantly different from those in other international centers and might be related to the choice of surgical method. In addition, elevated serum Ca levels in patients with primary hyperparathyroidism may affect insulin secretion.

Multiple endocrine neoplasia syndrome

Background. Multiple endocrine neoplasia type 1 is a rare inherited disease that combines heterogeneous autosomal inherited disorders, the pathogenesis of which is based on hyperplasia or tumor transformation of several neuro- endocrine glands. In this pathology, treatment protocols are insufficient. Surgical treatment, suppressive or replacement therapy, radiation and chemotherapy are mainly used.&#x0D; We presented a successful experience of combined radiotherapy of multiple pancreatic insulinoma as the main clinical manifestation of the syndrome of multiple endocrine neoplasia. The combination of intra-tissue brachytherapy and megavolt remote therapy in TFD, isoeffective 50 Gy, allowed to achieve reliable control of hypoglycemic attacks within 2 years of follow-up.&#x0D; Purpose – to acquaint the medical community with successful experience of combined radiation treatment of multiple pancreatic insulinoma as a main clinical manifestation of the multiple endocrine neoplasia syndrome.&#x0D; Materials and Methods. Clinical case of patient L., 30 years old, who received combined radiation therapy for clinically significant manifestations of hormonally active multiple insulinoma of the pancreas in the Department of Radiological Oncology of State Organization «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine».&#x0D; Results. In May 2019, palliative contact brachytherapy was performed on the MULTISOURCE device. Total focal dose (TFD) for cells in the pancreas GENUS 3 Gy 5 times a week, TFD 18 Gy. At the end of brachytherapy, attacks of hypoclycemia were stopped. In March 2020, remote radiation therapy was performed on a linear accelerator CLINAC-600C (6MeV) in the mode of classical fractionation (single focal dose (SFD) 1.8 Gy 5 times a week), TFD for the entire volume of the pancreas 30.6 Gy. In May 2021, CT scan showed that the process in the pancreas was stabilized, but in connection with the resumption of hypoglycemia and the emergence of dyshormonal osteopathy, a course of remote radiation therapy for the entire pancreas, SFD 1.8 Gy, TFD 20 Gy simultaneously with the introduction of bisphosphonates.&#x0D; Conclusions. Our patient demonstrates type I syndrome of multiple neo- plasms, neuroendocrine tumor of pancreas G1 T3N0M0 IIB stage. Due to multi-stage combined radiation therapy for 2 years it is possible to achieve stabilization of the process and reliable control of hypoglycemic attacks, which indicates the effectiveness of this method as an alternative to surgery in unresectable cases.

1873-P: Glycemic Impact of Pancreatic Enzyme Replacement in Patients with Diabetes and Exocrine Pancreatic Insufficiency: A Case Series

Some patients with type 2 diabetes (T2DM) and/or pancreatogenous diabetes have exocrine pancreatic insufficiency (EPI). The impact of pancreatic enzyme replacement (PER) on diabetes (DM) control is largely undocumented and unknown. We present 4 cases suggesting PER may positively impact DM glycemic and lipids. Case 1 is a 46 yr Caucasian (C) man with T2DM and recurrent gall stone pancreatitis. Prior to onset his HBA1c was between 6.3-7.4 but with recurrent episodes reached peak of 10.8. He was diagnosed with chronic pancreatitis with EPI and commenced PER. After 3 mths on PER his HBA1c was 6.7 with resolution of hypertriglyceridemia (HTG) and improved total cholesterol (TC). Case 2 is a 57 yr old C man with T2DM and episodic HTG related pancreatitis. He had erratic medication access due to insurance limitations. He was recently diagnosed with EPI but initially could not afford PER. HBA1c at diagnosis of EPI was 9.7 with elevated TC and HTG. When he secured PER, within 8 wks of use HBA1c reduced to 7.6 with improved HTG and TC. Case 3 is a 24 yr old C man with known cystic fibrosis and cystic fibrosis related DM. Initial HBA1c was 8.6 and he had been of PER voluntarily for yrs. He had features of EPI and was urged to resume PER which he did. At 4 mth follow up after restarting PER his HBA1c was 6.4 with improvement in HTG. Case 4 is a 36 yr old C man with prior well controlled T2DM and known MEN-1. His prior mean HBA1c was 6.7. Due to recurrent bouts of severe hypoglycemia in the prior 2 yrs work up revealed multiple pancreatic insulinomas for which he had partial pancreatectomy. His DM control declined with peak HBA1c of 11.3. He developed symptoms of EPI and was commenced on PER. 3mths after starting PER his HBA1c was 7.1 with resolution of HTG and improved TC. Early recognition of EPI in patients with DM is important. Commencement of PER in such patients may positively impact glycemia and dyslipidemia especially HTG. Further study of the relationship of PER to DM metabolic control is warranted. Disclosure G.I. Uwaifo: None.

Avoiding Pitfalls in Insulinomas by Preoperative Localization with a Dual Imaging Approach

Insulinomas are rare endocrine malignancies of the pancreas that require surgical resection but can be difficult to localize preoperatively. We sought to review and improve the accuracy of preoperative localization techniques at our institution. We retrospectively reviewed all insulinomas that underwent resection at our institution between 1998 and 2016. Localization techniques include selective arterial calcium stimulation (CaStim), CT, MRI, angiography, and somatostatin receptor scintigraphy. Thirty-eight patients had pathologically proven insulinomas on surgical resection. Localization accuracies of CaStim, CT, and MRI were 89 per cent (31/35), 67 per cent (22/33), and 46 per cent (11/24), respectively. When compared with CT alone and CaStim alone, the combination of these two modalities resulted in 100 per cent preoperative localization (30/30), whereas the use of CaStim alone resulted in 80 per cent (4/5) localization and the use of CT alone resulted in 66 per cent (2/3) localization. Four of our patients had both negative CT and MRI. Among these patients, CaStim was 100 per cent localizing and the only positive modality for these patients. These data confirm that CaStim is accurate in preoperatively identifying single and multiple insulinomas; and when combined with CT, this accuracy is increased to 100 per cent. Based on these data, we propose that a dual imaging approach is a superior means of preoperative localization.

Laparoscopic Distal Pancreatectomy for Insulinoma

Insulinomas are benign neuroendocrine tumors which are the most common of the pancreatic islet cell tumors, yet they remain a rarity. The incidence is 1-4 cases in one million patients a year. 60% are woman with a median age at presentation of 47 years. 90% are solitary and 10% multiple. More than 90% are benign adenomas and about 5%-6% of cases are malignant, and 5%-8% are associated with multiple endocrine neoplasms (MEN type I). Most insulinoma are 1-3 cm in size. Hyperinsulinism causes severe hypoglycemia and leads convulsion, depression and coma. Initial operation is curative in 88%, and long-term survival is normal. Recurrence rates of 7% (sporadic) and 21% (MEN type I) have been reported at 20 years. Clinical manifestation related with endogenous hyperinsulinism: autonomic (less specific) like sweat, worried, tremble, nausea, hungry palpitation and tingling. The more specific neuroglycopenic are confusion, changes of behavior, dizzy, headache, and weakness. The classic diagnostic criteria (Whipple’s triad): hypoglycemic symptoms, fasting hypoglycemic (&lt; 45 mg/dL) and reversal of changes with glucose. The treatment is surgical, except in advanced metastatic disease, where streptozotocin is helpful. Enucleation is performed for solitary insulinoma, and pancreas resection is performed for multiple insulinomas. Sometimes ultrasonography intra operative is useful to determine the insulinoma location. The surgical can be done by laparotomy or laparoscopic surgery. The benefit of laparoscopic surgery is small incisions, less pain, faster mobilization, short hospitalization and better cosmetic. In the other side, laparoscopic pancreatectomy should be done by experience surgeon with availability of supporting instruments. We report a case insulinoma in 39 years old woman. The locations were in body and tail pancreas. Laparoscopic distal pancreatectomy with spleen preservation is done successfully. The operation time was 3, 5 hours. Post-operative care in ICU for one day. We start enteral nutrition in the third day post-operative and the patient may leave hospital in the fifth day post-operative.

Non-syndromic multiple insulinomas with atypical clinico-biological presentation in two adult patients: a specific entity?

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Operation for insulinomas in multiple endocrine neoplasia type 1: When pancreatoduodenectomy is appropriate

Distal pancreatectomy is the most frequent operation for insulinomas complicating multiple endocrine neoplasia type 1 insulinoma, although there are conditions for which a different operative approach might be preferable. In this article, we report the operative experience of a referral center for multiple endocrine neoplasia type 1 insulinoma. Twelve patients underwent operations between 1992 and 2015: 8 underwent a distal pancreatic resection, and 4 underwent a pancreatoduodenectomy. Enucleation of other macroadenomas present in the remnant pancreas was performed in 9 out of these 12 patients. Operative complications (2 pancreatic fistulas and 2 cases of pancreatitis) occurred in 4 of the 8 distal pancreatic resections. In 1 patient, reoperation was required to resolve the complications of the first operation. At pathologic analysis, multiple insulinomas were found in 5 patients, lymph-nodal metastasis positive for insulin in 2 patients, multiple nonfunctioning pancreatic tumors in all patients, glucagonoma in 4 patients, and gastrinoma in the duodenum or lymph nodes in 4 patients. All the patients were treated successfully for the hypoglycemic/hyperinsulinemic syndrome with no clinical recurrence at a mean follow-up of 85months (range 4-242months). Recurrent nonfunctioning pancreatic tumor macroadenomas in the remnant pancreas occurred in only 1 of the 12 patients, and no progression of the gastrinomas was observed. None of the patients developed diabetes mellitus. Resection of the most severely affected part of the pancreas, whether left or right, associated with enucleation of concomitant macroadenomas in the preserved pancreas is recommended for the treatment of hypoglycemic/hyperinsulinemic syndrome and to prevent malignant progression of nonfunctioning pancreatic tumors in patients with multiple endocrine neoplasia type 1. If the head of the pancreas is the most affected site and the Zollinger-Ellison syndrome is concomitant, then pancreatoduodenectomy should be preferred over distal pancreatectomy.

Insulinoma: A multicenter, retrospective analysis of three decades of experience (1983–2014)

Abstract Objective To analyze the clinical features, diagnostic procedures, treatment, and clinical outcome of insulinomas diagnosed and treated in the period 1983–2014 in four Spanish hospitals. Methods All patients with either biochemical and morphological criteria of insulinoma and/or histological demonstration of insulin-secreting tumor were included. Results Twenty-nine patients [23 women (79.3%); mean age 48.7 ± 17.4 years (range, 16–74)] were recruited. Twenty-six patients (89.7%) had sporadic tumors, and the rest (3 women, 10.3%) developed in the context of multiple endocrine neoplasia type 1. There were 3 (10.3%) multiple insulinomas, one associated with multiple endocrine neoplasia type 1, and two (6.9%) malignant insulinomas, both sporadic. Most patients (n = 18, 62.1%) had fasting hypoglycemia, about a third (31%) both postprandial and fasting hypoglycemia, and 6.9% postprandial hypoglycemia only. Time to glucose nadir (37.3 ± 6.5 mg/dl) in the fasting test was 9.0 ± 4.4 h, with maximal insulin levels of 25.0 ± 20.3 μU/ml. Abdominal CT detected insulinoma in 75% of patients. Twenty-seven (93.1%) patients underwent surgery [enucleation, 18 (66.7%) and subtotal pancreatectomy, 9 (33.3%); tumor size, 1.7 ± 0.7 cm]. Surgery achieved cure in the majority (n = 24, 88.9%) of patients. Conclusion In our setting, insulinoma is usually a benign, small, and solitary tumor, mainly affecting women aged 45–50 years, and usually localized with abdominal CT. The most commonly used surgical technique is enucleation, which achieves a high cure rate.

Insulinoma: análisis multicéntrico y retrospectivo de la experiencia de 3 décadas (1983-2014)

ObjectiveTo analyze the clinical features, diagnostic procedures, treatment, and clinical outcome of insulinomas diagnosed and treated in the period 1983-2014 in four Spanish hospitals. MethodsAll patients with either biochemical and morphological criteria of insulinoma and/or histological demonstration of insulin-secreting tumor were included. ResultsTwenty-nine patients [23 women (79.3%); mean age 48.7±17.4 years (range, 16-74)] were recruited. Twenty-six patients (89.7%) had sporadic tumors, and the rest (3 women, 10.3%) developed in the context of multiple endocrine neoplasia type 1. There were 3 (10.3%) multiple insulinomas, one associated with multiple endocrine neoplasia type 1, and two (6.9%) malignant insulinomas, both sporadic. Most patients (n=18, 62.1%) had fasting hypoglycemia, about a third (31%) both postprandial and fasting hypoglycemia, and 6.9% postprandial hypoglycemia only. Time to glucose nadir (37.3±6.5mg/dL) in the fasting test was 9.0±4.4h, with maximal insulin levels of 25.0±20.3μU/mL. Abdominal CT detected insulinoma in 75% of patients. Twenty-seven (93.1%) patients underwent surgery [enucleation, 18 (66.7%) and subtotal pancreatectomy, 9 (33.3%); tumor size, 1,7±0,7cm]. Surgery achieved cure in the majority (n=24, 88.9%) of patients. ConclusionIn our setting, insulinoma is usually a benign, small, and solitary tumor, mainly affecting women aged 45-50 years, and usually localized with abdominal CT. The most commonly used surgical technique is enucleation, which achieves a high cure rate.

Mo1493 EUS-Guided Intratumoral Injection of CHST15 Dsrna for Unresectable Pancreatic Cancer: an Investigator-Initiated Trial

Mo1493 EUS-Guided Intratumoral Injection of CHST15 Dsrna for Unresectable Pancreatic Cancer: an Investigator-Initiated Trial

A Novel Germline Mutation ofMEN1Gene in a Young-aged Multiple Insulinoma with Hyperparathyroidism

A Novel Germline Mutation of<i>MEN1</i>Gene in a Young-aged Multiple Insulinoma with Hyperparathyroidism

A Novel Germline Mutation ofMEN1Gene in a Young-aged Multiple Insulinoma with Hyperparathyroidism

A Novel Germline Mutation of<i>MEN1</i>Gene in a Young-aged Multiple Insulinoma with Hyperparathyroidism

Insulinomatosis: a case report and review of literature

Objective To analyze the clinical and pathological characteristics of insulinomatosis,and to improve the awareness of the disease.Methods The clinical and pathological characters of a case of insulinomatosis diagnosed in Chinese PLA General Hospital and the pertinent literatures were analyzed and summarized.Results (1) Insulinomatosis mostly occurs in females and rarely develops metastases,the patients are considerably younger at diagnosis.The rate of recurrent hyper-insulinemic hypoglycemia episodes in insulinomatosis is higher than that in sporadic solitary insulinoma and MEN related insulinoma.(2) The typical character of insulinomatosis is the synchronous and metachronous occurrence of insulinomas.Micro-adenoma,macro-adenoma and insulin-expressing monohormonal endocrine cell clusters (IMECCs) can be found in the pathological photograph.(3) Total pancreatectomy was the bcst choice to treat insulinomatosis.(4) The etiology of insulinomatosis was still unclear,no MEN-1 mutation was found.Conclusion Insulinomatosis is characterized by the synchronous and metachronous occurrence of insulinomas,multiple insulinoma precursor lesions,and recurrent hypoglycemia. Key words: Insulinomatosis ; Hyperinsulinemic hypoglycemia; Insulinoma

Multiple Insulinomas Associated with Cystic Lesions: A Case Report

Multiple Insulinomas Associated with Cystic Lesions: A Case Report

Successful endoscopic ultrasound‐guided ethanol ablation of multiple insulinomas accompanied with multiple endocrine neoplasia type 1

Successful endoscopic ultrasound‐guided ethanol ablation of multiple insulinomas accompanied with multiple endocrine neoplasia type 1