Insulinoma

Febiansyah Ibrahim

Introduction
Insulin-secreting tumors of pancreatic
origin that cause hypoglycemia
the most common functioning
endocrine neoplasm of the pancreas
90% of insulinomas benign,
90% are solitary, >
90% occur at intrapancreatic sites, and
90% are < 2 cm

Introduction
Incidense estimated 1-4 per 1 000
000/year
Median age of patients 47 years
Females show a slight predominance
over males (59%)

Malignant Insulinoma
Confirmed by presence of extrapancreatic locoregional, lymph-node or
remote extension
Based on pathology
Insulinoma of uncertain prognosis (size
greater than 2 cm or grade 2 based on the
2010 WHO classification, or vascular and/or
perineural invasion or necrosis)
Benign insulinoma if none of the above

Very rare 4-14% insulinoma cases

Clinical Signs
Hypoglycemia related to endogenous
hyperinsulinism
Autonomic symptoms
Diaphroresis
Tremor
Palpitations

Neuroglycopenenic symptoms
confusion,
behavioral changes,
Personality changes,
visual disturbances
Seizures
Coma
[

Diagnosis

Diagnosis
Fasting tests
Laboratory Findings
CT-scan/MRI
Sensitivity33%-64% and 40%-90%

EUS
Intraoperative US
Arterial stimulation venous sampling
(ASVS)

 EUS
86.6%-92.3%
Homogeneously hypoechoic
Rounded in shape
Distinct margins
Dependent on the examiners
experience
Location of tumors
Advance with FNA Biopsy

ASVS
94% to 100%
Well-defined, round or oval vascular
blushes that are of increased
vascularity compared with the
surrounding normal pancreatic
parenchyma
Venous sampling

Treatment
Surgery is the treatment of choice for
insulinoma and has an extremely
high success rate
Medical treatment
Unable or unwilling to undergo surgical
treatment, for preoperative control of
blood glucose levels
Unresectable metastatic disease

Medical Treatment
Low-dose ethanol ablation
Oral everoilimus can reduce the volume
of tumor through decreasing the
secretion of insulin or insulingen
Diazoxide to relieve the
neuroglycopenic symptoms
Streptozotocin intravenously to control
the hyperglycemic disorder by inhibiting
the biosynthesis of insulin in cell.

Surgical Treatment
Only treatment-modality with the potential to
cure patients with insulinoma
Choice of procedure will depend on the features
of the tumor mass (type, size, and localization)
Enucleation is the procedure of choice for all
benign insulinomas
Blind distal pancreatectomy has been
considered the standard surgical procedure,
when a tumor could be not visualized and/or
palpated intraoperatively

Surgical Treatment
Malignant Insulinoma
Aggressive attempts at resection
(Pancreatoduodenectomy or distal
pancreatectomy)

Laparoscopic
Distal pancreatectomy
Benign, small, and/or located in the
body or tail of the pancreas

Surgical Treatment
Radical resection
Not single,
Not well-capsulated,
> 4 cm in diameter, and
Involves or is near the main pancreatic
duct

Surgical Treatment
Complications
Fistula
Intra-abdominal collection
Infection
Pseudocyst

 Thank You