DIAGNOSTIC AND THERAPEUTIC STRATEGY FOR M ULTIPLE INSULINOMAS

Four of 59 patients with organic hyperinsulinism had multiple insulino mas and two patients a micro- and macroadenomatosis. Excluding patient s with adenomatosis 3 of 10 tumors could be detected preoperatively by ultrasound (5 of 10 by CT). 6 of 7 macroadenomas could be visualized by angiography. Intraoperatively 9 of 10 macroadenomas were palpable. The nonpalpable tumor could be localized by intraoperative ultrasound. Pancreatic resection had better results than multiple enucleations. E xcisional biopsy is recommended to exclude nesidioblastosis or microad enomatosis.