Laparoscopic surgery for pancreatic insulinomas: an update

Chrysanthi Aggeli, Alexander M. Nixon,Ioannis Karoumpalis, Gregory Kaltsas, George N. Zografos

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Insulinomas are the most common functioning neuroendocrine tumors of the pancreas, occurring in almost 1-4 per 1 million persons each year. In contrast to other pancreatic neuroendocrine tumors, they are usually benign and solitary at the time of diagnosis. Due to their benign nature, surgical excision is the treatment of choice, with excellent long-term results. The introduction of minimally invasive techniques in the surgical treatment of insulinoma has been gaining popularity …

Glycemic control in patients with insulinoma

Agata Matej, Hanna Bujwid, Jakub Wroński

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Insulinoma is the most common neuroendocrine tumor of the pancreas. Surgical management of insulinomas is considered to be the only curative method. However, effective glycemic control preoperatively and in unresectable insulinomas remains a significant issue …

Preoperative imaging and localization of small sized insulinoma with EUS-guided fine needle tattoing: a case report

George N. Zografos, Alexandra Stathopoulou, George Mitropapas, John Karoubalis, George Kontogeorgos, Gregory Kaltsas, George Piaditis, George I. Papastratis

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We report a case of an insulinoma that was not identified on either Computerized Tomography (CT) scan and Magnetic Resonance Imaging (MRI). Endoscopic ultrasonography (EUS) revealed a small insulinoma located at the body of the pancreas, which was histologically confirmed. The patient underwent a laparotomy but no tumour was identified either on palpation or with intra-operative ultrasound …

Anatomical localization of insulinomas: still a need to combine a set of diagnostic procedures

Gianluca Tamagno, Donal O’Shea

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The diagnosis of insulinoma is based on universally defined clinical and laboratory parameters (Whipple triad and fasting test). Pre-operative tumor localization is the main challenge in the diagnostic management of insulinomas. The pre-operative and/or intra-operative localization …

Reversal of impaired counterregulatory cortisol response following diazoxide treatment in a patient with non insulinoma pancreatogenous hypoglycemia syndrome: Case report and overview of pathogenetic mechanisms

Stelios Fountoulakis, Dimosthenis Malliopoulos, Labrini Papanastasiou, Theodora Pappa, George Karydas, George Piaditis

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OBJECTIVE: Non-insulinoma pancreatogenous hypoglycemia syndrome (NIPHS) is one of the rare causes of endogenous hyperinsulinism. Its diagnosis is challenging and may require selective intraarterial calcium stimulation and concomitant hepatic vein sampling (SACVS). Impaired counterregulatory hormones’ production in response to hypoglycemia …

Pasireotide for malignant insulinoma

Amit Tirosh, Salomon M. Stemmer, Evgeny Solomonov, Eldad Elnekave, Wolfgang Saeger, Yelena Ravkin, Kobi Nir, Yeela Talmor, Ilan Shimon

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Malignant insulinoma usually has a poor prognosis, as no efficient medical treatment is available. The somatostatin analogs octreotide and lanreotide have limited ability to control the hypoglycemic events. Pasireotide is a multi-receptor targeted somatostatin-analog with improved affinity for SSTR5. There is to date no reported treatment experience with this drug in such tumors …