Microsoft powerpoint - insulinomas – experience from an institution in south

INSULINOMAS – EXPERIENCE FROM AN INSTITUTION IN SOUTH INDIA
Thomas V Paul*, Ben Selvan**, Jubbin Jacob*, Aravindan Nair** Esther Evelyn J*, Nihal Thomas*,
Simon Rajaratnam*, Senthil Vasan K*, M.S.Seshadri*
*Department of Endocrinology, ** Department of Endocrine Surgery.
Christian Medical College, Vellore 632 004, Tamil Nadu, India
Insulinoma is the most common cause of hypoglycaemia due to endogenous
hyperinsulinism in adults with an incidence of 1 per 250,000 patient-years
ƒRetrospective analysis of subjects with Insulinoma
who received treatment from 1992 till August 2004.
ƒTotal number of subjects - 18.
ƒData analyzed using a 9.0 SPSS software package.
Presentation
Hypoglycaemic Neuropathy
Presenting Symptoms
PRESENTING SYMPTOMS*
SEIZURES
WEIGHT GAIN
AUTONOMIC
Hypoglycaemic Neuropathy
AGE OF PRESENTATION
SYMPTOMS
CONCIOUSNESS
SYMPTOMS
*Not mutually exclusive
The mean duration of symptoms prior to
Age group
diagnosis is <1 year in 66.7% subjects.
Serum Insulin levels at point
Other Pre-op Localization
of hypoglycaemia (µIU/ml)
Modalities
INSULIN VALUES
Mass in the
Uncinate
Sensitivity Specificity
Computerized Tomography 10 /14
NUMBER OF PATIENTS
Sensitivity 62.5% & Specificity 100%
Intra-op Location
Management
No tumour
TYPE OF SURGERY
Uncinate/
Surgical
Dilantin
Diazoxide
Prednisolone
14 subjects
Histopathology
Outcomes
Conclusions
underwent surgery,
11 had normalization
of glycemic status.
„ CT scan has a good positive predictive
Low <50
1 developed diabetes
Malignant
postoperatively .
High >200
„ Majority of subjects who underwent
surgery are in remission.
„ Age at presentation, prevalence of
No Complication
malignancy and the site of occurrence
Acute Pancreatitis/
Hemorrhage/ Fistula
were similar to other series*.
Extra Pancreatic
* Clive SG.1999 Surgical aspects of HyperinsulinemicHypoglycemia.
Endocrinol Metab Clin North Am 28:533-54

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