Insulinoma

Question 1

What is an insulinoma?

Answer 1

An insulinoma is a neoplasm of the beta cells of the pancreas.

Question 2

What are the principal manifestations of an

insulinoma?

Answer 2

An insulinoma causes hypersecretion of insulin which results in severe hypoglycemia and its sequelae including depression, seizures, and coma.

Question 3

What is the primary treatment for an insulinoma?

Answer 3

Treatment for an insulinoma is surgical excision of the metastatic tumor. In advanced cases, the entire distal pancreas may have to be excised. This is referred to as a Child procedure.

Question 4

What medical treatment may be used as a
temporizing measure prior to surgical excision of an
insulinoma?

Answer 4

Patients are often managed preoperatively with diazoxide which inhibits insulin release from beta cells.

Question 5

What is the primary anesthetic goal for the
management of a patient undergoing surgical
excision of an insulinoma?

Answer 5

The primary goal is maintaining a normal blood glucose level. Surgical manipulation of the tumor may result in profound hypoglycemia. Hyperglycemia may result rapidly after excision
of the tumor. It is accepted that glucose-containing fluids should be administered intravenously during the surgery as many of the symptoms of hypoglycemia (diaphoresis, tachycardia, and hypertension) may not be noticeable during
anesthesia. Blood glucose levels should be checked every 15 minutes during the procedure.