Vázquez Quintana Enrique
Bol Asoc Med P R. 2004 Jan-Feb;96(1):33-8.
Insulinoma is the most common endocrine tumor of the pancreas. Over 90% of the insulinomas are benign and single, and can be cured by simple excision. Depending on the location, insulinomas can be enucleated, might require partial or distal pancreatectomy or pancreaticoduodenectomy. Five cases with insulinoma successfully treated by surgical intervention, two by enuclation, two by distal pancreatectomy and splenectomy, and preservation of the spleen have been summarized. The management of insulinoma involves the diagnosis, localization of the tumor and treatment. Insulinomas are rare tumors of the pancreas. Nevertheless, it is the most common endocrine tumor of the pancreas. Specifically arising from the beta cells, of the islets of Langerham, that produce insulin (fig.1). Its incidence is one in 250,000 inhabitants. It can be seen at any age, but is more frequent in females between 4 and 82 years of age, with a mean of 45.5 years. Insulinomas are evenly distributed between the head, body and tail of the pancreas. Over 90% are benign and single and can be cured by simple excision. Depending on the location insulinomas can be enucleated, might require partial or distal pancreatectomy or a pancreaticoduodenectomy. Ten percent could be malignant when metastasis to peripancreatic lymph nodes or to the liver is detected. The course of the patient with malignant insulinoma is an indolent one. The release of insulin leads to fasting hypoglycemia producing confusion, loss of consciousness, coma or convulsions. The hypoglycemia in turn can induce the release of cathecolamines producing tachycardia, tremulousness and diaphoresis. The Whipple's triad must be present for the diagnosis of insulinoma; symptoms of hypoglycemia, glucose level below 50 mgs/dl and relief of symptoms by the administration of glucose. In large series the interval between the onset of symptoms and a definitive diagnosis of insulinoma was 37 months, with a range of 0 to 14 years.
胰岛素瘤是胰腺最常见的内分泌肿瘤。超过90%的胰岛素瘤是良性且单发的，通过简单切除即可治愈。根据肿瘤位置，胰岛素瘤可进行剜除术，可能需要部分或远端胰腺切除术或胰十二指肠切除术。总结了5例通过手术干预成功治疗的胰岛素瘤病例，2例采用剜除术，2例采用远端胰腺切除术加脾切除术，还有1例保留了脾脏。胰岛素瘤的治疗包括诊断、肿瘤定位和治疗。胰岛素瘤是胰腺的罕见肿瘤。然而，它是胰腺最常见的内分泌肿瘤。具体起源于分泌胰岛素的胰岛β细胞（图1）。其发病率为每25万居民中有1例。可发生于任何年龄，但在4至82岁的女性中更为常见，平均年龄为45.5岁。胰岛素瘤在胰腺的头、体、尾部分布均匀。超过90%是良性且单发的，通过简单切除即可治愈。根据位置，胰岛素瘤可进行剜除术，可能需要部分或远端胰腺切除术或胰十二指肠切除术。当检测到转移至胰腺周围淋巴结或肝脏时，10%的胰岛素瘤可能为恶性。恶性胰岛素瘤患者的病程发展缓慢。胰岛素释放导致空腹低血糖，引起意识模糊、意识丧失、昏迷或抽搐。低血糖反过来又可诱导儿茶酚胺释放，导致心动过速、震颤和出汗。诊断胰岛素瘤必须具备Whipple三联征：低血糖症状、血糖水平低于50mg/dl以及给予葡萄糖后症状缓解。在大量病例系列中，从症状出现到胰岛素瘤确诊的间隔时间为37个月，范围为0至14年。
