Characteristics and Outcomes of 79 Patients with an Insulinoma: A Nationwide Retrospective Study in Finland

Abstract

Objective Insulinomas are rare pancreatic tumours. Population-based data on their incidence, clinical picture, diagnosis, and treatment are almost nonexistent. The aim of this study was to clarify these aspects in a nationwide cohort of insulinoma patients diagnosed during three decades. Design and Methods Retrospective analysis on all adult patients diagnosed with insulinoma in Finland during 1980–2010. Results Seventy-nine patients were diagnosed with insulinoma over the research period. The median follow-up from diagnosis to last control visit was one (min 0, max 31) year. The incidence increased from 0.5/million/year in the 1980s to 0.9/million/year in the 2000s (p = 0.002). The median diagnostic delay was 13 months and did not change over the study period. The mean age at diagnosis was 52 (SD 16) years. The overall imaging sensitivity improved from 39% in the 1980s to 98% in the 2000s (p < 0.001). Seventy-one (90%) of the patients underwent surgery with a curative aim, two (3%) had palliative surgery, and 6 (8%) were inoperable. There were no significant differences in the types of surgical procedures between the 1980s, 1990s, and 2000s; tumour enucleations comprised 43% of the operations, distal pancreatic resections 45%, and pancreaticoduodenectomies 12%, over the whole study period. Of the patients who underwent surgery with a curative aim, 89% had a full recovery. Postoperative complications occurred in half of the patients, but postoperative mortality was rare. Conclusions The incidence of insulinomas has increased during the past three decades. Despite the improved diagnostic options, diagnostic delay has remained unchanged. To shorten the delay, clinicians should be informed and alert to consider the possibility of hypoglycemia and insulinoma, when symptomatic attacks are investigated in different sectors of the healthcare system. Developing the surgical treatment is another major target, in order to lower the overall complication rate, without compromising the high cure rate of insulinomas.

Insulinoma in pregnancy (a case presentation and systematic review of the literature)

“…2,40 Hypoglycemia becomes symptomatic with plasma glucose levels below 50 mg/dL (2.8 mmol/L). 8,40,41 Symptoms can be divided into neuroglycopenic and autonomic symptoms, a physiological response of the adrenergic and cholinergic systems to low plasma glucose. [1][2][3][40][41][42] Additional psychiatric symptoms may lead to severe and prolonged misdiagnosing.…”

Long‐term health‐related quality of life in persons diagnosed with an insulinoma in Finland 1980‐2010

“…In our previous retrospective study on insulinoma, we described the incidence, clinical picture, diagnostics and treatment of all adult Finnish patients diagnosed with an insulinoma in 1980-2010. 4 The research register includes data on the clinical picture, laboratory findings, imaging, pathology, surgical and medical treatment, and the follow-up of the patients with an insulinoma. The decisions on the treatment and follow-up of insulinoma patients were made by a multidisciplinary expert team in one of the five University Hospitals in Finland.…”

“…16,17 The participants were also asked about their current height and weight, and their regular medications. The information obtained from the questionnaires was combined with the clinical data of the insulinoma register, 4 to evaluate factors associated with the HRQoL of insulinoma patients. The mean 15D scores and the 15D profiles between the patients and the controls were compared with the independent samples t test.…”

“…[1][2][3] Patients with a malignant insulinoma have a median survival of less than 2 years. 2 Despite the improved diagnostic options, the diagnostic delay has remained long, 4 and little is known about the long-term prognosis of patients with an insulinoma.…”

“…5,[7][8][9] The HRQoL of insulinoma patients has not been studied before. The aim of this study was to evaluate the long-term HRQoL in a nationwide Finnish insulinoma cohort, 4 and to investigate the factors determining the HRQoL of patients with a previously treated insulinoma.…”