REOPERATIVE SURGERY FOR ORGANIC HYPERINSULINISM - INDICATIONS AND OPERATIVE STRATEGY

Organic hyperinsulinism has a good chance of cure by operation, althou gh patients with diffuse of multiple disease run a high risk of recurr ence or persistence of disease. Surgical management and outcome in the se patients are presented and discussed. Between 1986 and April 1997 a total of 62 patients mere operated on for organic hyperinsulinism [so litary 48, multiple, 3, multiple endocrine neoplasia type I (REN-I) 2, diffuse 4, malignant 5]. Persistence or recurrence occurred in 10 pat ients (16%). Among the six that persisted, four were malignant and two benign. All four of those that recurred were benign. Patients with be nign disease presented with multiple tumors (n = 3), MEN-I syndrome (n = 1), and diffuse/nodular hyperplasia (n = a). The duration between d iagnosis and reintervention ranged from I to 10 years. Preoperative di agnosis was able to localize tumors in three patients (computed tomogr aphy I, angiography 2, calcium stimulation 1). Operative procedures we re multiple enucleations in two patients with sporadic disease, subtot al resection plus enucleation in the case of MEN-I syndrome, subtotal resection for diffuse hyperplasia, left resection for adenomatosis, an d turner extirpation after multiple previous operations. Long-term cli nical and biochemical cure was achieved in five of six patients (mean follow-up 5 gears). Octreotide therapy shows good symptomatic control in the patient with operative failure. Reintervention for organic hype rinsulinism is successful (80% cure) and requires preoperative imaging and individual surgical management.