ORGANIC HYPERINSULINISM - DO WE NEED TO L OCALIZE THE INSULINOMA BEFORE APPLYING TREATMENT

Background: The need for preoperative localization of an insulinoma is still under discussion. The aim of the present study was to determine the usefulness of preoperative localization of the tumour, to investi gate the operative risk and to analyse the long-term course. Patients and Methods: The sensitivity of the diagnostic workup was investigated prospectively in 26 patients operated on between 1.9.1985 and 31.8.19 94 for hyperinsulinism at the surgical department of the university ho spital in Mainz. Results: In the case of solitary adenomas the sensiti vity of preoperative sonography was 43%, that of CT 57%, and that of a ngiography 85%. Intraoperatively, all solitary adenomas were palpable and were to be seen at sonography. In a patient with multiple adenomas , only one tumour was seen sonographically. The postoperative course w as unremarkable in 18 out of 27 operations on the pancreas; two patien ts died later. After a mean follow-up of 51 months, all patients were free of hypoglycaemic attacks. Conclusions: The results show that loca lization of the tumour prior to the first operation is no longer neces sary in patients with no MEN syndrome. In the presence of the later, h owever, it is recommended despite its low sensitivity. Although a perm anent cure is possible with surgery, the morbidity of the operation is not negligible.