J.Jpn. Surg. Soc.. 80(11): 1035-1039, 1979

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Report on the annual meeting

A STUDY OF 22 CASES OF INSULINOMA

22 patients with insulinoma treated at this institute during 1935－1979 were studied. Whipple's triad was demonstrated in all but one case. Results of repeated daily determination after overnight fast were : blood glucose levels below 50 mg/dl in all cases, plasma insulin levels above 50 μU / ml in 6 of 12 cases, IRI/glucose ratios above 0.3 in all of 12 cases.
Blood glucose or insulin responses to tolbutamide, leucine and glucagon were diagnostic in 7 of 9 cases, 5 of 6 cases and 3 of 6 cases, respectively.
Selective angiography visualized tumor blushes in 8 of 12 cases. Venous sampling by percutaneous portal vein catheterization gave excellent localization of 3 insulinomas.
lntraoperative blood glucose responses after removal of tumors were diagnostic in 5 of 8 cases.
There were a sigle tumor in 19 cases and multiple tumors in 3 cases. The distribution of all tumors within the pancreas was: 7 in the head (3 occult), 10 in the body, 11 in the tail (1 occult). 20 cases were cured by distal pancreatectomy (14 cases) or enucleation of tumors (6 cases). Another 2 cases with occult tumors in the head of the pancreas were cured finally by blind total pancreatectomy or blind 80% distal pancreatectomy. Pathological diagnosis was: 27 tumors benign, one tumor malignant (1st case).
Tumors of the last two cases were proved by extraction to produce insulin and other multiple hormones.

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