Further Inpatient Care

After insulinoma resection, hyperglycemia may persist for 48-72 hours because of chronic down-regulation of insulin-receptors by the previously high circulating insulin levels secreted by the tumor and the suppression of normal pancreatic B cells. Small subcutaneous doses of insulin every 3-6 hours may be necessary if plasma glucose level exceeds 300 mg/dL (16.7 mmol/L).

Patients with major pancreatic resections may develop diabetes mellitus.

Streptozocin chemotherapy appears to be toxic to cells that produce insulin. For insulinomas, some cases of sustained improvement in hypoglycemic attacks have been reported, particularly when streptozotocin has been used.

Short-acting somatostatin analogues may be tried to control insulin release. In patients with unresectable metastatic disease to the liver, when systemic chemotherapy was unsuccessful, embolization of the hepatic artery and intraarterial chemotherapy may be indicated to control symptoms and hormone release, to inhibit tumor growth, and to improve survival.^[71]

Inpatient & Outpatient Medications

Continue diazoxide and hydrochlorothiazide in patients who are not fit for surgery or when tumor resection was unsuccessful.

Transfer

In advanced metastatic disease, the indications for chemotherapy or other interventional treatments must be emphasized in a multidisciplinary way and discussed with surgeons, specialists in chemoembolization, gastroenterologists, endocrinologists, and medical oncologists.

Complications

See the list below:

Surgical complications (eg, pancreatic leakage) occur in about 5% of patients; the surgical complication rate has improved significantly in recent years.
Pseudocysts
Pancreatitis
Abscess
Other complications include intestinal obstruction, pleural effusion, hemorrhage, and fistula formation
Permanent diabetes mellitus may occur in about 5% of patients, mainly in those who undergo major pancreatic resections

Prognosis

Approximately 90-95% of insulinomas are benign. Long-term cure with complete resolution of preoperative symptoms is expected after complete resection.

Recurrence of benign insulinomas was observed in 5.4% of patients in a series of 120 patients over a period of 4-17 years. The same diagnostic and therapeutic approach was recommended, including surgical exploration and tumor resection.^[72]

Patients may develop nonfunctioning metastatic disease to the liver up to 14 years after insulinoma resection.^[73]Note that some insulinomas are indolent (depending on the tumor biology), resulting in prolonged survival.

Questions

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Media Gallery

CT scan image with oral and intravenous contrast in a patient with biochemical evidence of insulinoma. The 3-cm contrast-enhancing neoplasm (arrow) is seen in the tail of the pancreas (P) posterior to the stomach (S) (Yeo, 1993).
Endoscopic ultrasonography in a patient with an insulinoma. The hypoechoic neoplasm (arrows) is seen in the body of the pancreas anterior to the splenic vein (SV) (Rosch, 1992).