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What should be done in an operating room when an insulinoma cannot be found?

Abstract
Insulinoma is the most common (functioning) islet cell tumour of the pancreas and is highly curable with accurate localization and precise extirpation of the often benign, solitary lesion. Although previous reports describe high success rates without pre-operative localization, more recent recognition of the overlap among causes of endogenous hyperinsulinism, coupled with the deleterious long-term effects of blind distal pancreatectomy and re-operation, mandate the need for precise pre-operative localization or regionalization of the tumour(s). If these criteria have not been met and the surgeon finds him/herself in the operating room without a localized or regionalized tumour, the operation should be concluded without resection, the diagnosis reconfirmed, and a calcium stimulation test performed. At experienced centres, this can be often carried out within 24-48 h and the patient returned to the operating room for a gradient-guided resection. Intraoperative venous sampling for insulin might be an option in the future but its accuracy has not been validated in sufficient numbers of patients to date.
AuthorsNassir Rostambeigi, Geoffrey B Thompson
JournalClinical endocrinology (Clin Endocrinol (Oxf)) Vol. 70 Issue 4 Pg. 512-5 (Apr 2009) ISSN: 1365-2265 [Electronic] England
PMID19170712 (Publication Type: Journal Article)
Chemical References
  • Insulin
  • Calcium
Topics
  • Calcium (pharmacology)
  • Contraindications
  • Humans
  • Insulin (blood)
  • Insulinoma (diagnosis, diagnostic imaging, surgery)
  • Intraoperative Period
  • Pancreas (diagnostic imaging, drug effects, metabolism)
  • Pancreatectomy
  • Pancreatic Neoplasms (diagnosis, diagnostic imaging, surgery)
  • Ultrasonography

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