Patients with insulinoma usually present with significant neuroglycopenic symptoms. The preferred diagnostic test is a controlled and monitored fast, measuring blood levels of glucose, insulin, C-peptide, and proinsulin. Surreptitious hypoglycemia should be considered and ruled out. Screening for the presence of multiple endocrine neoplasia type 1 (MEN-1) by family history, as well as for other associated endocrine abnormalities, is an essential part of the evaluation. In patients with sporadic insulinoma, the tumor is generally singular, small, benign, and can appear anywhere within the pancreas. Radiographic localization studies are indicated to identify the tumor or to identify the region (head, body, or tail) of the pancreas that contains the tumor. Medical therapy can control some of the symptoms but, ultimately, surgical intervention is necessary. The goal of surgery for insulinoma is precise removal of tumor without sacrificing normal tissue. Intraoperative ultrasound can identify some occult tumors, reducing the need for extensive pancreatic resection. Surgical results are excellent for patients with sporadic disease: greater than 90percnt; are cured. Patients with MEN-1 have multiple islet cell tumors, and surgical results are less satisfactory. Most patients, however, will have improvement of hypoglycemia following surgery.
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