What is the treatment of Insulinoma?

Surgery to remove the tumour is the treatment of choice for insulinoma. The details of the procedure are described later, but the principles are:

• check for any evidence of malignancy or spread of the tumour
• precisely locate the tumour using ultrasound and palpation
• remove the tumour with a margin of normal tissue around it to ensure its complete removal

Medical approaches are used to render the patient safe before, during and after the operation. Pre-operatively, this entails dietary advice to prevent hypoglycaemic attacks. The night before surgery, intravenous dextrose solution is given to maintain blood glucose levels during surgery. Then, during operation, the glucose levels are continuously checked, and glucose or insulin given appropriately to maintain normal levels. Post-operatively, a normal hyperglycaemia occurs (due to the removal of insulin that the body was getting used to) but this should resolve in under a week. This rarely requires further insulin therapy.

How successful is the treatment?

With an experienced surgeon, success rates are around 95%.

What are the possible complications of surgery?

These include:

• diabetes
• hypoglycaemia can persist rarely, mainly in those with malignant disease
• haemorrhage (bleeding) during operation
• abscess formation
• pancreatitis (an inflamed pancreas)
• fistula formation (abnormal connections) made between the pancreatic duct and bile duct