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Case Report
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| Insulinoma located in the head of the pancreas: Is there an alternative to surgery? | ||||||
| Marcin Balawejder1, Katarzyna Skórkowska-Telichowska2, Tomasz Kuniej3, Renata Tuchendler4 | ||||||
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1MD, Internal Medicine Resident; Department of Endocrinology, Clinic of Internal Medicine, 4th Military Hospital, Wroclaw, Poland.
2MD, PhD, Clinical Instructor; Department of Endocrinology, Clinic of Internal Medicine, 4th Military Hospital, Wroclaw, Poland. 3MD, Clinical Instructor; Department of Radiology and Diagnostic Imaging, 4th Military Hospital, Wroclaw, Poland. 4MD, PhD Departament of Endocrinology Head; Department of Endocrinology, Clinic of Internal Medicine, 4th Military Hospital, Wroclaw, Poland. | ||||||
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| Balawejder M, Skórkowska-Telichowska K, Kuniej T, Tuchendler R. Insulinoma located in the head of the pancreas: Is there an alternative to surgery? International Journal of Case Reports and Images 2014;5(4):285–294. |
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Abstract
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Introduction:
Insulinoma is a gastrointestinal tumor, usually benign, which derived from pancreatic beta cells and typically induced by endogenous hyperinsulinism with an incidence rate of 1–4 cases per million inhabitants each year. This case report describes the diagnostic challenges and dilemmas associated with finding optimal treatment for an insulinoma located in the head of the pancreas.
Case Report: A 41-year-old female was presented with recurrent, nagging headaches, loss of attention and episodes of anxiety accompanied by a feeling of 'heart palpitation'. Based on the test results, reactive hypoglycemia was diagnosed and further symptomatic treatment was recommended. The patient was admitted again nine years after her initial hospitalization for symptoms of hypoglycemia. Abnormally, high insulin and peptide C secretion was found. Computed tomography (CT) scan revealed a tumor with a size of 1.8x1.3x2.2 cm located within the uncinate process of the pancreas. Pancreatoduodenectomy was recommended. However, the patient refused surgery. She was given somatostatin analogues leading to a satisfactory clinical effect. Computed angiotomography was done which confirmed the presence of an abundantly vascularized tumor within the head of the pancreas. Embolization with histoacryl glue was performed. Due to the ineffectiveness of embolization, treatment with short-acting and then long-acting synthetic somatostatin analogues was reintroduced. A follow-up CT scan conducted six months after the procedure revealed regression of tumor size. Conclusion: Treatment of choice for insulinoma is surgery, but conservative treatment is recommended when surgery is impossible or contraindicated. Afferent vessel embolization is a safe treatment option. Chemotherapy may be an option for inoperable, malignant tumors. | |
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Keywords:
Insulinoma, Hypoglycemia, Somatostatin analogues, Afferent vessel embolization
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Author Contributions
Marcin Balawejder – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Katarzyna Skórkowska-Telichowska – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Tomasz Kuniej – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Renata Tuchendler – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© Marcin Balawejder et al. 2014; This article is distributed the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.) |
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