FUNCTIONING PANCREATIC ISLET CELL ADENOMAS

Abstract

A review of 258 cases of insulin-secreting pancreatic islet cell adenomas or insulinomas reported in the literature up to 1949. Cases were analyzed with regard to age and sex of patients, number, size and incidence of malignancy of tumors, association with other endocrine abnormalities, symptoms and diagnosis, and treatment. Such tumors may occur at any age, but are commonest in 4th to 6th decades, with no significant difference in sex distribution. Multiple tumors present in 12% of cases. 90% of reported tumors are benign. Diagnosis depends on nervous or gastro- intestinal disturbances coming on in the fasting state associated with hypoglycemia with blood sugar values below 50 mg./100 ml. and immediate relief of symptoms following the ingestion of glucose. Symptoms related to hy-peradrenalinism induced by hypoglycemia are common. Glucose-tolerance tests and electroencephalogram studies are not diagnostic. Because of the association of hypoglycemia with dysfunction of the anterior pituitary and adrenal cortex, the authors advocate the use of the subcut. epinephrine test for pituitary adrenal cortical insufficiency and the 4-hr. ACTH tests to rule out pituitary and adrenal cortical hypofunction. Surgical extirpation of the tumor is advocated as curative if the patient is adequately prepd. and treated pre- and post-operatively.