CONTRIBUTION OF ARTIFICIAL PANCREAS IN DI AGNOSIS AND SURGICAL-TREATMENT OF INSULINOMAS

Insulinomas are often hard to diagnose and difficult to locate during surgery. We tested the contribution of artificial pancreas (AP) for ca se management of our last eight patients including two cases with mult iple insulinomas. When diagnosis is uncertain, the euglycemic hyperins ulinic clamp technique under AP is a safe method to assess inappropria te insulin secretion characterized by a high plasma level of C peptide not inhibited by insulin injection. During surgery the AP provides a feed back controlled glucose infusion and thus maintains blood glucose above a predefined level. It allows a safe operation, preventing sudd en hypoglycemia. By providing continuous data about intensity of gluco se infusion and blood glucose, it helps to detect an occult secreting tumor (a preoperative therapeutic test with diazoxide requires stoppin g treatment for at least one month before surgery to avoid false negat ive results) and confirms the total ablation of abnormal insulin-produ cing cells. Peroperative monitoring curves of glucose infusion and blo od glucose related to exploration and ablation procedures illustrate t he contribution of this method in helping surgical treatment which can be perfectly adapted to the lesions as shown by the total recovery of our eight patients (mean follow-up : 43.2 months).