Insulinoma: approaches to diagnosis and treatment

Abstract

A review of the literature deals with the most common functioning neuroendocrine tumor of β-cells of the islets of Langerhans of the pancreas, which is characterized by uncontrolled insulin production. Pathophysiological basis of clinical manifestations of tumors from β-cells of the islets of Langerhans are due to the hormonal activity of these tumors. In the absence of subordination to the physiological mechanisms that regulate glucose homeostasis, β-cell adenomas lead to the development of chronic hypoglycemia. Taking into consideration that the symptoms of insulinoma occur due to hyperinsulinemia and hypoglycemia, the severity of clinical manifestations of the disease in each case indicates the individual sensitivity of the patient to insulin and low blood sugar. The vast majority of insulin-producing tumors of the pancreas have a size that does not exceed 0.5–2 cm in diameter, which makes it difficult to detect them during surgery. Thus, in 20 % of patients with the first, and sometimes with the second and third operations, it is not possible to detect tumor. Malignant insulinomas occur in 10–15 % of cases, and a third of them metastasize. The only radical treatment for insulinoma is surgery. Conservative treatments are used only in inoperable patients, as well as the means that temporarily eliminate hypoglycemia and are used to prepare the patient for surgical treatment. It is emphasized that the successful treatment of patients with endogenous hyperinsulinism requires a comprehensive team approach, which includes the use of modern imaging techniques and high-tech treatments.