Insulinoma: Cost-effective Care in Patients with a Rare Disease
Authors: Lloyd Axelrod
Journal: Annals of Internal Medicine (1995)

Editorials15 August 1995Insulinoma: Cost-effective Care in Patients with a Rare DiseaseLloyd Axelrod, MDLloyd Axelrod, MDMassachusetts General Hospital, Boston, MA 02114Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-123-4-199508150-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail An insulinoma is the quintessential example of the elusive but curable endocrine disorder. It is a rare condition, estimated to occur four times per million person-years [1], and has nonspecific neurologic and adrenergic manifestations. It frequently eludes diagnosis for years. The neurologic manifestations, especially those that affect behavior and consciousness, are often frightening and embarrassing to those who have this condition and to those around them. An insulinoma is potentially lethal. Once identified, it is curable by surgery [1]. When an isolated benign insulinoma is removed (and most are benign), the patient has a normal life expectancy [1]. A patient ...References1. Service FJ, McMahon MM, O'Brien PC, Ballard DJ. Functioning insulinoma—incidence, recurrence, and long-term survival of patients: a 60-year study. Mayo Clin Proc. 1991; 66:711-9. Google Scholar2. Wilder RM, Allan FN, Power MH, Robertson HE. Carcinoma of the islands of the pancreas. Hyperinsulinism and hypoglycemia. JAMA. 1927; 89:348-55. Google Scholar3. Whipple AO. The surgical therapy of hyperinsulinism. J Int Chir. 1938; 3:237-76. Google Scholar4. Whipple AO. Hyperinsulinism in relation to pancreatic tumors. Surgery. 1944; 16:289-305. Google Scholar5. Service FJ. Hypoglycemias. J Clin Endocrinol Metab. 1993; 76:269-72. Google Scholar6. Service FJ, O'Brien PC, McMahon MM, Kao PC. C-peptide during the prolonged fast in insulinoma. J Clin Endocrinol Metab. 1993; 76:655-9. Google Scholar7. Service FJ. Hypoglycemic disorders. N Engl J Med. 1995; 332:1144-52. Google Scholar8. Daggett PR, Goodburn EA, Kurtz AB, Le Quesne LP, Morris DV, Nabarro JD, et al. Is preoperative localisation of insulinomas necessary? Lancet. 1981; 1:483-6. Google Scholar9. Galiber AK, Reading CC, Charboneau JW, Sheedy PF II, James EM, Gorman B, et al. Localization of pancreatic insulinoma: comparison of pre- and intraoperative US with CT and angiography. Radiology. 1988; 166:405-8. Google Scholar10. Doherty GM, Doppman JL, Shawker TH, Miller DL, Eastman RC, Gorden P, et al. Results of a prospective strategy to diagnose, localize, and resect insulinomas. Surgery. 1991; 110:989-97. Google Scholar11. King CM, Reznek RH, Dacie JE, Wass JA. Imaging islet cell tumours. Clin Radiol. 1994; 49:295-303. Google Scholar12. Doppman JL, Chang R, Fraker DL, Norton JA, Alexander HR, Miller DL, et al. Localization of insulinomas to regions of the pancreas by intraarterial stimulation with calcium. Ann Intern Med. 1995; 123:269-73. Google Scholar13. Rosch T, Lightdale CJ, Botet JF, Boyce GA, Sivak MV Jr, Yasuda K, et al. Localization of pancreatic endocrine tumors by endoscopic ultrasonography. N Engl J Med. 1992; 326; 1721-6. Google Scholar Author, Article, and Disclosure InformationAffiliations: Massachusetts General Hospital, Boston, MA 02114Corresponding Author: Lloyd Axelrod, MD, Diabetes Unit, Bulfinch 408, Massachusetts General Hospital, 32 Fruit Street, Boston, MA 02114. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoLocalization of Insulinomas to Regions of the Pancreas by Intra-arterial Stimulation with Calcium John L. Doppman , Richard Chang , Douglas L. Fraker , Jeffrey A. Norton , H. Richard Alexander , Donald L. Miller , Elaine Collier , Monica C. Skarulis , and Phillip Gorden Metrics Cited byILaparoscopic Enulceation and Distal Pancreatectomy for Pancreatic InsulinomasPreoperative localization of pancreatic insulinoma by super selective arterial stimulation with venous samplingHypoglycemiaSelective Intra-Arterial Calcium Stimulation with Hepatic Venous Sampling for Preoperative Localization of InsulinomasEndocrine tumours of the pancreasValue of intra-arterial calcium stimulated venous sampling for regionalization of pancreatic insulinomasSevere Chronic Hypoglycemia in a Lean, Young WomanPancreatic endocrine tumour: a 22-year clinico-pathological experience with morphological, immunohistochemical observation and a review of the literatureAdvances in the diagnosis and treatment of gastrointestinal neuroendocrine tumors 15 August 1995Volume 123, Issue 4Page: 311-312KeywordsCalciumGastroenterology and hepatologyGlucoseHypoglycemiaInsulinomaMagnetic resonance imagingMesenteric arteriesSurgeonsSurgeryUltrasound imaging Issue Published: 15 August 1995 Copyright & PermissionsCopyright © 1995 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...